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. Author manuscript; available in PMC: 2019 May 10.
Published in final edited form as: AIDS Behav. 2017 Sep;21(9):2736–2745. doi: 10.1007/s10461-016-1534-3

Psychological stressors and coping strategies used by adolescents living with and not living with HIV infection in Nigeria

Morenike O Folayan 1, Carlos F Cáceres 2, Nadia A Sam-Agudu 3,4, Morolake Odetoyinbo 5, Jamila K Stockman 6, Abigail Harrison 7
PMCID: PMC6510022  NIHMSID: NIHMS1021810  PMID: 27605363

Abstract

Introduction

Little is known about stressful triggers and coping strategies of Nigerian adolescents and whether or not, and how, HIV infection modulates these sources of stress and coping. This study evaluated differences in stressors and coping strategies among Nigerian adolescents based on HIV status.

Method

We analysed the data of six hundred 10–19 year old adolescents recruited through a population-based survey from 12 States of Nigeria who self-reported their HIV status. Data on stressors and coping strategies were retrieved by self-report from participants, using a validated structured questionnaire. We compared results between adolescents with and without HIV with respect to identification of specific life events as stressors, and use of specific coping strategies to manage stress. Logistic regression analysis adjusted for age and sex.

Results

Adolescents living with HIV (ALHIV) had significantly increased odds of identifying ‘having to visit the hospital regularly’ (AOR: 5.85; 95%CI: 2.11–16.20; P=0.001), and ‘having to take drugs regularly’ (AOR: 9.70; 95%CI: 4.13–22.81; P<0.001) as stressors. ‘Seeking social support’ (AOR: 3.14; 95%CI: 1.99–4.93; p<0.001) and “using mental disengagement’ (OR: 1.64; 95%CI: 0.49–1.84; p=0.001) were coping strategies. Adolescents not living with HIV had significantly increased odds of identifying ‘argument with a friend or family member’ as a stressor (AOR: 6.59; 95%CI: 3.62–11.98; P<0.001).

Conclusion

Life events related to adolescents’ HIV positive status were significant stressors for ALHIV. Providing targeted psychosocial support could help reduce the impact of such HIV status-related stressors on ALHIV.

Keywords: HIV, adolescents, stressors, coping strategies, Nigeria

INTRODUCTION

The World Health Organization defines adolescents as individuals between 10 and 19 years of age, in a transition period between childhood and adulthood, during which they experience events or challenges that may present or may be perceived as life stressors [1]. These stressors include concerns with body image, social identity, sexuality and conformity, peer networks, and independence [2], issues that are often seen as central in their development [2]. Some adolescents find ways to cope with such stressors, while others repeatedly fail to do so. The inability to effectively cope with life stressors may lead to depression [3], maladaptive behavior [4], anxiety, posttraumatic stress disorder [5, 6], and suicidal behaviors including attempts and ideation [7].

Stress and its effects often emerge during adolescence, given the role of emotional changes in this period [8]. Stress from the social environment appears to be more intense than other types of stressors and significantly contributes to psychopathology if left unmanaged [9,10].Social stress arises from the need to develop healthy relationships with peers, meet the expectations of school and peers, and manage family-related responsibilities [11].

Adolescents living with HIV (ALHIV) and those affected by HIV may experience a higher level of stress than their HIV-uninfected peers [12–14]. HIV infection often fundamentally alters the social ecology underlying healthy child development by disrupting variables at the individual, family and peer/community levels, which often serve to mitigate risks and promote resilience [15]. For example, considering parents as a family level variable, HIV may threaten an adolescent’s mental health when it negatively impacts their parents’ mental health and results in parental depression and possibly risk behaviors such as substance use [16], poor interpersonal functioning and intimate partner violence [17], the need to change schools, or a death in the family [18].

At the individual level, ALHIV have to deal with issues relating to their HIV status, including issues related to receiving information about their HIV status, disclosing their HIV status to others, choosing partners and practicing safe sex, and adhering to HIV treatment [2] and living with the stress and trauma of being diagnosed with HIV infection [19]. The concurrent presence of other HIV-related stressors such as stigma and discrimination, sexual abuse and abandonment [18, 20] further predisposes ALHIV to psychological distress which may be expressed through problematic behavior, including poor treatment adherence, risky sexual practices, and the use of recreational drugs [21–23].

Recent studies suggest that the potential of a stressor to cause mental health problems depends not only on the severity of the stress exposure but also on the resilience of the individual [24, 25] and the coping strategies employed [26]. To cope with stressors, individuals often develop or adopt different coping strategies to help moderate the stressors [27].Coping strategies can be emotional (e.g. crying, excessive eating, confrontation) [27, 28], avoidance-based (e.g. isolation, mental disengagement, behavioral disengagement, alcohol and other psychoactive drug use, suppression of competing activities) [28,29] or adaptive strategies (e.g. seeking social support, problem-solving, positive re-appraisal, acceptance, humor, journaling, religion) [28, 29].The ability to cope with stressors from chronic illnesses such as HIV infection however differs by age, gender and cultural context [30,31]: younger children generally lack specific coping strategies while male adolescents report greater use of avoidance/distraction techniques when compared to females [32, 33].

Unfortunately, little is known about the major sources of stress experienced by African adolescents living with HIV, and what types of coping strategies, if any, they adopt to mitigate stress. Studies conducted in adolescents in Rwanda, Uganda and Kenya showed that repeated experiences of loss and stigma due to HIV/AIDS were a cause of stress [32, 34], and so were medical difficulties and relationship challenges associated with HIV status disclosure [32]. Coping strategies often used are religion, [32, 35], social support [32], avoidance [32], and distraction [32].

The need to study country context of mental health and its expression had been highlighted as culture modulates how stress is perceived, expressed and coped with [34]. It is important to explore how adolescents deal with HIV in Nigeria, located in West Africa, as the most populous country in Africa experiencing the second highest burden of ALHIV in the world. At the end of 2013, it was estimated that 54,633 new infections occurred among young Nigerians 15 to 24 years of age [36], and these young people are likely living in highly stressful environments. Nigeria was rated the most stressful country in a 74-country Bloomberg rankings study using 7 variables (homicide rate, gross domestic product per capita, income inequality, corruption, unemployment rate, air pollution, and life expectancy) [37]. With an unemployment rate of nearly 25% and life expectancy of only 53 years [37]- sources of stress and responsive coping strategies among Nigerian adolescents may differ from those described elsewhere; and hence, programmatic strategies to promote mental health among these adolescents may require the conduct of additional research aimed at identifying and fine-tuning specific elements that can ensure effectiveness [38]. This study was therefore developed to explore the main sources of mental stress and describe the coping strategies used, if any, to mitigate stress by ALHIV in Nigeria. A comparative group of adolescents living without HIV infection was included to highlight any differences in the context of the presence or absence of HIV infection.

METHODS

This is a secondary analysis of data generated through a cross-sectional survey conducted in 2012 to assess the sexual and reproductive health of ALHIV in Nigeria. Data collected included details on stressors and coping strategies employed when faced with life events. Independent analyses of the original data, with description of the study methodology, have previously been reported by Folayan et al [29, 39, 40]. Study participants comprised female and male adolescents aged 10–19 years with diverse ethnic backgrounds in Nigeria. This study also builds on an earlier analysis by these authors on stress factors and coping mechanisms used by adolescents who self-reported forced sexual initiation [29]. Our analysis was limited to 600 (38.1%) of the 1,574 study participants who reported a prior HIV test and indicated their HIV status was positive or negative.

Recruitment

Details about the sample recruitment procedures have been described elsewhere [29, 39]. Briefly, the first stage of recruitment involved the stratification of the 18 states hosting the first 25 antiretroviral therapy (ART) treatment sites in Nigeria into six geopolitical zones. Two states were randomly selected from each of the six geopolitical zones, including Lagos, Oyo, Imo, Enugu, Edo, Rivers, Kaduna, Kano, Borno, Adamawa, Plateau and Benue.

Next, two groups of adolescents were recruited from each State, based on self-report of HIV status: (1) ALHIV; and (2) adolescents who reported being HIV negative and those who did not know their HIV status

To recruit ALHIV, the study was introduced to physicians managing people living with HIV (PLHIV) at treatment centres, PLHIV attending support group meetings and members of the Network of Youths Living with HIV in each state. These contacts helped share information about the study and referred ALHIV interested in participating in the study to research team members. A maximum of 80 HIV positive adolescents were to be recruited in each of the 12 states for a total of up to 960 study participants.

Recruitment of adolescents aged 10–19 years who were HIV negative took place at youth centres or places frequented by adolescents and youths. Clusters of youths from which study participants were recruited were located within the geographical areas where treatment sites were located, to ensure that the recruitment sites for ALHIV and HIV-negative/untested adolescents did not differ significantly. No recruitment of study participants took place in schools, to ensure that both out-of-school and in-school youths were adequately represented in the study sample.

Data Collection

Data were collected using a face-to-face interviewer-administered structured questionnaire in English, adopted from the 2007 National AIDS and Reproductive Health Survey [41]. Some key and sensitive words/phrases for each selected community were translated into local dialects during the training of interviewers. Interviewers used the semi-translated versions as master copies. A similar approach was successfully used for other studies with adolescents and youth in Nigeria [42–45].

Information collected included gender, age and self-reported HIV status.The structured questionnaire also contained questions regarding 19 potentially stressful life events and 13 coping strategies. The 19-item stress scale included questions related to family, peers and school. The 13-item coping scale included questions that explored the use of avoidance and adaptive coping strategies. Study participants were required to respond “Yes” or “No” to each of the questions inquiring whether those life events caused stress to them regularly, and “Yes” or “No” to each of the questions inquiring whether they used those coping strategies regularly. This instrument measuring stress inducers and coping strategies had been previously validated and used in Nigeria [29].

Study Variables

Our independent variable was self-reported HIV status. Study outcomes were life events self-perceived as stressors, and coping mechanisms used.

Data Analysis

Participants’ self-reported HIV status was categorised into two groups: self-reported negative status, and self-reported HIV positive status. Age was grouped into 10–14 years (younger adolescents) and 15–19 years (older adolescents). Pearson’s Chi square was used to determine the association between self-reported HIV status and the life events perceived as stressors. We also explored whether or not there was an association between self-reported HIV status and coping strategies. Where a statistically significant association was found between the self-reported HIV status and any of the stressor or coping strategy, a logistic regression analysis using forward selection was used for the inferential analysis. Only factors whose p value was ≤0.05 during the tests of association entered into the model to determine the odds of an adolescent living with or not living with HIV identifying that item as a stressor or using a coping strategy. Each analysis was controlled for age group and gender. Analyses were conducted using STATA version 11.0 (StataCorp LP, College Station, USA).

Compliance with ethical standards

Ethics approval for the study was obtained from the National Institute of Medical Research Institutional Review Board, the Health Research Ethics Committee of Plateau State, and the Health Research Ethics Committee of the Federal Capital Territory, Abuja. Informed consent was sought from adolescents 15 years and older. Parental consent and participant assent were obtained for participants 10 to 14 years old.

RESULTS

Demographic profile of study participants

Table I highlights the age, gender and HIV status profile of the study participants. The study participants consisted of 151 (25.2%) self-reported HIV negative and 449 (74.8%) self-reported/contact-referred HIV positive adolescents. There were 285 (47.5%) males and 315 (52.5%) females in the sample; approximately one third was in the 10–14 years old age group and approximately two-thirds were in the 15–19 age group. There was no significant difference in the distribution of study participants recruited by gender and HIV status (p=0.06), but there were more 10–14 years old adolescents who were HIV positive and more 15–19 years old adolescents who were HIV negative recruited into the study (p<0.001).

Table I:

Age and gender distribution of study participants by HIV status (N=600)

Variables Total (N=600) n (%) HIV status
HIV-negative (N=151) n (%) HIV-positive (N=449) n (%) X2 (p value)
Gender
Male 285 (47.5) 68 (45.0) 217 (48.3) 3.64 (0.06)
Female 315 (52.5) 83 (55.0) 232 (51.7)
Age
10–14 years 187 (31.2) 11 (7.3) 176 (39.2) 53.65 (<0.001)
15–19 years 413 (68.8) 140 (92.7) 273 (60.8)
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Experience of stressors

Table II highlights the proportion of adolescents who experience events as stressors, according to their HIV status. When compared with adolescents not living with HIV, significantly more ALHIV identified the following as stressors: ‘having to visit the hospital regularly’ (p<0.001); ‘having to take drugs regularly’ (p<0.001); ‘handling the death of a loved one’ (p<0.001); ‘dealing with stigma and discrimination’ (p<0.001); ‘thinking about death’ (p<0.001); ‘body looks different from others’ (p<0.001); ‘may never have children’ (p=0.02); and ‘not adhering to my medications’ (p<0.001). Likewise, significantly more HIV- negative adolescents identified the following as stressors when compared with ALHIV: ‘pressure from peers to do what I do not believe in’ (p<0.001), ‘pressures from parents to do what I do not believe in’ (p=0.008), ‘need to excel in my academic performance in school’ (p=0.001), ‘extra work from school or home (p<0.001)’, ‘argument with a friend or family member (p<0.001)’, ‘having problems with boy/girlfriend or spouse (p<0.001)’, and ‘someone saying something about you that you don’t like (p=0.006)’.

Table II:

Perceived stressors and HIV status among adolescents in Nigeria (N=600)

Stressors HIV status
HIV-negative (N=151) n (%) HIV-positive (N=449) n (%) X2 P value
Pressure from peers to do what I do not believe in 66 (43.7) 127 (28.3) 12.32 <0.001
Pressure from parents to do what I do not believe 50 (33.1) 100 (22.3) 7.08 0.008
Having to visit the hospital regularly 6 (4.0) 259 (57.7) 132.19 <0.001
Having to take drugs regularly 10 (6.6) 280 (62.4) 140.58 <0.001
Need to excel in my academic performance in school 57 (37.7) 105 (23.4) 11.83 0.001
Conforming to religious beliefs 24 (15.9) 54 (7.6) 1.49 0.22
Handling the death of a loved one 19 (12.6) 121 (26.9) 13.04 <0.001
Dealing with stigma and discrimination 15 (9.9) 215 (47.9) 20.25 <0.001
Thinking about death 13 (8.6) 171 (38.1) 46.17 <0.001
Body looks different from others 10 (6.6) 97 (21.6) 17.31 <0.001
May never have children 8 (5.3) 55 (12.2) 5.81 0.02
Do not have friends 12 (7.9) 51 (11.4) 1.40 0.24
Not in a sexual relationship with someone 9 (6.0) 31 (6.9) 0.16 0.69
Do not have good relationship with my care provider 14 (9.3) 37 (8.2) 0.15 0.69
Not adhering to my medications 8 (5.3) 110 (24.5) 26.37 <0.001
Extra work from school or home 64. (42.4) 103 (22.9) 21.27 <0.001
Argument with a friend or family member 59 (39.1) 40 (8.9) 74.63 <0.001
Having problems with boy/girlfriend or spouse 43 (28.5) 59 (13.1) 18.84 <0.001
Someone saying something about you that you don’t like 47 (37.1) 97 (21.6) 7.52 0.006
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Table III highlights the results of multiple logistic regression analysis to determine the factors that caused stress for adolescents living with HIV when compared with adolescents not living with HIV in Nigeria, controlling for age-group and gender. ALHIV had significantly increased odds of identifying the following factors as stressors when compared with adolescents not living with HIV, respectively: ‘having to visit the hospital regularly’ (AOR: 5.85; 95%CI: 2.11–16.20; p=0.001); and ‘having to take drugs regularly’ (AOR: 9.70; 95%CI: 4.13–22.81; p<0.001).

Table III:

Independent associations between perception of live events as stressors for adolescents living with HIV as compared to adolescents not living with HIV in Nigeria (N=600)

Variables Adjusted Odds ratio Confidence interval P value
Having to visit the hospital regularly
Adolescents not living with HIV 1 - -
ALHIV 5.85 2.11–16.20 0.001
Having to take drugs regularly
Adolescents not living with HIV 1 - -
ALHIV 9.70 4.13–22.81 <0.001
Handling the death of a loved one
Adolescents not living with HIV 1 - -
ALHIV 0.94 0.43–2.04 0.88
Dealing with stigma and discrimination
Adolescents not living with HIV 1 - -
ALHIV 1.63 0.71–3.73 0.25
Thinking about death
Adolescents not living with HIV 1 - -
ALHIV 2.20 0.96–5.03 0.06
Body looks different from others
Adolescents not living with HIV 1 - -
ALHIV 0.54 0.19–1.52 0.24
May never have children
Adolescents not living with HIV 1 - -
ALHIV 0.34 0.09–1.20 0.09
Not adhering to my medications
Adolescents not living with HIV 1 - -
ALHIV 2.03 0.65–6.30 0.22
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Table IV highlights the results of multiple logistic regression analysis to determine the factors that caused stress for adolescents not living with HIV when compared with adolescents living with HIV in Nigeria, controlling for age-group and gender. Adolescents not living with HIV had significantly increased odds of identifying ‘Argument with a friend or family member’ as a stressor when compared with ALHIV (AOR: 6.59; 95%CI: 3.62–11.98; p<0.001).

Table IV:

Independent associations between perception of live events as stressors for adolescents not living with HIV as compared to adolescents living with HIV in Nigeria (N=600)

Variables Adjusted Odds ratio Confidence interval P value
Pressures from peers to do what I do not believe in
ALHIV 1 - -
Adolescents not living with HIV 1.45 0.85–2.47 0.17
Pressure from parents to do what I do not believe in
ALHIV 1 - -
Adolescents not living with HIV 0.74 0.40–1.37 0.34
Need to excel in my academic performance in school
ALHIV 1 - -
Adolescents not living with HIV 1.28 0.75–2.19 0.37
Extra work from school or home
ALHIV 1 - -
Adolescents not living with HIV 1.59 0.93–2.73 0.09
Argument with a friend or family member
ALHIV 1 - -
Adolescents not living with HIV 6.59 3.62–11.98 <0.001
Having problems with boy/girlfriend or spouse
ALHIV 1 - -
Adolescents not living with HIV 1.67 0.92–3.02 0.09
Someone saying something about you that you don’t like
ALHIV 1 - -
Adolescents not living with HIV 0.60 0.32–1.11 0.10
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Coping strategies

Table V highlights the proportion of adolescents who use different coping mechanisms when faced with stress, according to their HIV status. More ALHIV used the following coping mechanisms when faced with stress when compared with adolescents not living with HIV: ‘seeking social support (p<0.001)’, religion (p=0.004)’; and mental disengagement (p=0.03). Likewise, more adolescents not living with HIV used the following strategies when compared with ALHIV: ‘positive appraisal’ (p=0.03) and humour (p=0.02).

Table V:

Reported use of coping strategies, as related to HIV status among adolescents in Nigeria (N=600)

Coping strategies HIV status
HIV negative (N=151) HIV positive (N=449) X2 P value
Confrontation 54 (35.8%) 148 (33.0%) 0.4 0.53
Seek social support 61 (40.4%) 271 (60.4%) 18.21 <0.001
Planful problem solving 56 (37.1%) 160 (35.6%) 0.1 0.75
Religion 62 (41.1%) 245 (54.6%) 8.25 0.004
Positive appraisal 57 (37.7%) 128 (28.5%) 4.52 0.03
Acceptance 54 (35.8%) 175 (39.0%) 0.49 0.48
Escape/denial 25 (16.6%) 74 (16.5%) 0.0005 0.98
Mental disengagement 30 (19.9%) 112 (24.9%) 4.99 0.03
Behavioral disengagement 27 (17.9) 115 (25.6%) 3.74 0.053
Alcohol/drug use 13 (8.6%) 43 (9.6%) 0.13 0.72
Humor 45 (29.8%) 91 (20.3%) 5.86 0.02
Suppression of competing activities 29 (19.2%) 66 (14.7%) 1.72 0.19
Journaling 16 (10.6%) 46 (10.2%) 0.02 0.9
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Table IV displays the results of the multiple logistic regression analysis to determine the independent associations between HIV infection and specific coping strategies, controlling for age group and gender. ALHIV had significantly increased odds of identifying ‘seeking social support’ (OR: 3.14; 95%CI: 1.99–4.93; p<0.001) and using mental disengagement (OR: 1.64; 95%CI: 0.49–1.84; p=0.001) as coping strategies when compared with adolescents not living with HIV. No coping strategy was found independently associated with being HIV negative.

DISCUSSION

The study was able to highlight two key findings. First, there were significant differences in events perceived as stressors by ALHIV and by adolescents not living with HIV: “having to visit the hospital” and “having to take drugs regularly” were significant stressors for ALHIV; while “argument with a friend or family member” was a significant stressor for adolescents not living with HIV. Second, there were differences in the use of specific coping strategies by HIV status: to cope with stress, ALHIV were more likely to use both social support and mental disengagement versus adolescents not living with HIV.

The findings of this study showed that an adolescent’s HIV status bears a significant impact on the type of events that cause them stress. This can be interpreted to imply that HIV infection is associated with unique stressors among adolescents. Like other studies [22, 46, 47], this study highlights that adherence to antiretroviral therapy can be stressful and challenging for ALHIV. Similarly, the proximity to adulthood thrusts upon them an increasing responsibility over their own health care, which also becomes stressful [48]. One other stressor identified for ALHIV in this study is the need for regular hospital visits. Reports from Nigeria have identified that hospital visits can be challenging for people living with HIV due to stigma [51–53], the poor attitudes of staff in HIV treatment facilities [51], high cost of transportation [52],long waiting hours [52] and concerns with confidentiality [53, 54].

Providing psychosocial support helps to improve adherence to antiretroviral therapy among ALHIV [21, 48, 49] and this study highlights that ALHIV use a lot more of social support to cope with stress than do their peers not living with HIV. Moreover, psychosocial support can help enhance the ability of adolescents to handle long-term consequences of risk behaviors beyond drug adherence [50]. As social support is not necessarily available to all ALHIV in Nigeria, access to it should be facilitated to help them deal with challenges associated with both hospital visits and adherence to medications.

Importantly, this study shows that HIV infection affects adolescents’ experiences in complex ways. Given the social and health-related meaning of HIV infection, ALHIV seem subject to stress caused by individual-level health concerns, while they seem less worried about issues that are more salient to adolescents not living with HIV, particularly issues that affect their relationships with others. Further studies are required to understand those differences and their implications for psychosocial support in the management of HIV infection amongst adolescents.

Likewise, more ALHIV than adolescents not living with HIV used social support as a coping strategy. While the characteristics of the social support sought after to improve their coping ability were not explored, the finding may point to the need to explore the viability of support groups for ALHIV in Nigeria. Prior studies had identified support groups for ALHIV as vital for facilitating coping with stress [55, 56].

This study also demonstrated that more ALHIV used mental disengagement as a coping strategy just as previous studies had identified [3, 57]. While further assessments of the way this strategy is used are warranted, it is likely that mental disengagement is used as a denial-based coping strategy, which may be socially sustained by the persistence of stigma and discrimination against persons living with HIV in Nigeria, leading to frequent feelings of shame, fear, humiliation, and anger [58]. Future studies will need to explore the operation and correlates of mental disengagement as a coping strategy by ALHIV in Nigeria, and identify interventions needed to enhance the ability of ALHIV to cope with personal contexts associated with the use of mental disengagement.

This study has a number of limitations. First is the prospect for type I error: the sample size for this data analysis was less than 40% of the original sample for the study. Second, there was skewness in the proportion of study participants recruited: more adolescents aged 15–19 years old and more adolescents living with HIV were recruited to the study. Furthermore, the study only included 600 participants who reported their HIV status hence limiting the generalizability of our study findings to adolescents who get tested for HIV. Also, the use of self-reports for HIV status may not accurately reflect the actual HIV status of some study participants, mainly those reporting negative or unknown serostatus, possibly due to stigma, confidentiality concerns or social desirability. We were unable to control for adverse physical and mental health effects in our analysis as this was not collected in the primary study, neither were the time points of measurements that took place specified. Finally, in order to prevent the scenario of too few ALHIV and needing to recruit similar sub-samples of HIV positive and HIV negative adolescents, the primary study purposefully sought to recruit more ALHIV to obtain similar numbers of both groups. However, given the low proportion of adolescents who test for HIV in Nigeria [59], recruitment of HIV negative adolescents proved more difficult and the study ultimately recruited a higher number of ALHIV. In any event, the proportion of ALHIV was defined by our recruitment strategy, and does not affect the validity of our analysis; importantly, it should not be interpreted as an estimate of the prevalence of HIV among adolescents in Nigeria.

Despite these limitations, this study has contributed to further our understanding of how HIV infection in a setting with high levels of stress and stigma such as Nigeria, modulates perceptions about stressors and the use of coping strategies. It is the first study to highlight the association between stressors, coping strategies and HIV among ALHIV in Nigeria. Our findings stress the need for targeted programs in school, clinic, and community-based settings in Nigeria that address stigma and discrimination specific to HIV while bolstering social and peer support networks. Policies that promote health care provider education focused on the unique issues that ALHIV face can facilitate integration of social support services within HIV care services. Collectively, these approaches can maximize improvements in HIV care and treatment for ALHIV.

CONCLUSION

In conclusion, there are significant differences in the type of events that cause stress, and the stress coping strategies used by adolescents living with and without HIV infection in Nigeria. Psychosocial support targeting the highly-ranked HIV-related stressors, for example through peer mentors and support groups, may be successful in supporting the development of positive coping mechanisms and improving mental health among adolescents living with HIV. Future studies should develop/adapt and validate relevant strategies to address this need.

Table VI:

Independent Associations between Coping Strategies and HIV Status among Adolescents in Nigeria (N=600)

Coping strategies used adolescents living with HIV compared with adolescents not living with HIV
Variables N (%) Adjusted Odds ratio Confidence interval P value
Seek social support
Adolescents not living with HIV 61(40.4) 1 - -
ALHIV 271 (60.4) 3.14 1.99–4.93 <0.001
Religion
Adolescents not living with HIV 62 (41.1) 1 - -
ALHIV 245 (54.6) 1.34 0.85–2.10 0.20
Positive appraisal
Adolescents not living with HIV 57 (37.7) 1 - -
ALHIV 128 (28.5) 0.90 0.76–1.07 0.23
Mental disengagement
Adolescents not living with HIV 30 (19.9) 1 - -
ALHIV 112 (24.9) 1.64 0.49–1.84 0.001
Humor
Adolescents not living with HIV 45 (29.8) 1 - -
ALHIV 91 (20.3) 0.94 0.78–1.13 0.49
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Footnotes

Conflict of interest

The authors declare that they have no conflict of interest

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