Sixteen study participants were participated in the study. Their age ranges from 25-65 years. (See table 1 for detail sociodemographic variables of the study participants)
Table 1 Socio-Demographic characteristics of the study participant (N=16) who are on ART in Tach Gayint district in 2021
Code
|
Sex
|
Age
|
Years with
HIV
|
ART year
|
Educational status
|
Religion
|
Occupational status
|
Marital status
|
Resident
|
P1
|
F
|
37
|
4
|
4
|
Did not attend
|
Orthodox
|
Alcohol cashier
|
Divorced
|
Urban
|
P2
|
M
|
41
|
8
|
8
|
Degree
|
Orthodox
|
Civil servant
|
Married
|
Urban
|
P3
|
F
|
25
|
3
|
2
|
elementary
|
Orthodox
|
Housewife
|
Married
|
Urban
|
P4
|
F
|
65
|
10
|
10
|
Did not attend
|
Protestant
|
no work
|
Widowed
|
Urban
|
P5
|
F
|
40
|
12
|
10
|
Did not attend
|
Orthodox
|
no work
|
Divorced
|
Urban
|
P6
|
F
|
30
|
12
|
6
|
Did not attend
|
Orthodox
|
Housewife
|
Married
|
Urban
|
P7
|
F
|
37
|
8
|
8
|
Did not attend
|
Orthodox
|
Shopkeeper
|
Divorced
|
Urban
|
P8
|
F
|
30
|
4
|
4
|
Secondary
|
Orthodox
|
Farmer
|
Married
|
Urban
|
P9
|
M
|
44
|
8
|
8
|
Elementary
|
Orthodox
|
Farmer
|
Married
|
Rural
|
P10
|
M
|
30
|
2.5
|
2.5
|
Diploma
|
Orthodox
|
Teacher
|
Married
|
Urban
|
P11
|
F
|
45
|
7
|
7
|
Did not attend
|
Orthodox
|
Alcohol cashier
|
Divorced
|
Urban
|
P12
|
Me
|
42
|
10
|
10
|
Secondary
|
Orthodox
|
Barber
|
Married
|
Urban
|
P13
|
M
|
43
|
9
|
7
|
Did not attend
|
Orthodox
|
Carpenter
|
Married
|
Urban
|
P14
|
M
|
55
|
5
|
5
|
Secondary
|
Orthodox
|
Merchant
|
Married
|
Urban
|
P15
|
M
|
50
|
6
|
6
|
Elementary l
|
Orthodox
|
Farmer
|
Married
|
Urban
|
P16
|
M
|
40
|
11
|
8
|
Secondary
|
Orthodox
|
Merchant
|
Married
|
Urban
|
Note: M=MALE
F=female
Years=number years living with HIV since diagnosis
Participants experience
The following main themes were explored with sub-themes: psychological experience, social experience, economical experience and anti-retroviral treatment interruption.
Theme1: Psychological experiences
Experience of boredom, fear of being infected and Feeling of uncertainty about future ART drug availability were shared by most study participants. People whose family members were in foreign countries seemed to be more terrified and anxious. Most study participants reported COVID-19 brought negative psychological experience on them. They expressed feeling of anxiety, worried, depression, fear, tension, sadness and hopelessness.Three sub-themes namely fear of dying, feeling of uncertainty about future ART drug availability in the nearby health institutions and perception on severity of COVID-19 were identified.
Fear of dying
Participants explained that COVID-19 made them to experience fear of dying in their future life. They heard the severity of COVID-19 is more in people with immune compromised patient and this made them to be in extreme fear. Due to fear of dying participants were exposed to psychological problem and they reported as they were not spending normal life due to the existence of the new virus called COVID-19.
“People said to me “HIV patients will die first if corona infects them (yibilagnlachihu)…” when I hear this; I worry for myself and feel depressed. Internally I was demoralized at that time.” A 43 years old male participant stated
Especially at the initial stage of the pandemic in our country, study participants mentioned that they were in extreme tension and lack of hopefulness in their future lives. They were assuming as they will die immediately if they were contracted by the new virus.
In contrast to the above stated response of participants, few participants narrated that they did not feel anything related to the pandemic of COVID-19. Among of these one female participant explained as she did not know the severity of COVID -19 on people living with HIV/AIDS.
Feeling of uncertainty about future ART drug accessibility and availability
Participants narrated that they were uncertain what happened to their drug for the future. Most of them worried about the future availability of anti-retroviral therapy (ART) due to COVID-19. They mentioned shortage of drug for the future was their major concern. They stated as they knew ART drug is imported from aboard and if exchanging of goods and services stopped with other countries, ART medication would not be easily available to them and this condition made them to be uncertain for their medication.
“I worry for the future about the availability of drug [ART]. If the drug is interrupted, we will not stay even for one day. This was my… [Stress]” 40 years female participant
Perception on severity of COVID-19
Almost all participants explained as they heard and accept the severity of COVID-19 on them. When they asked about severity of COVID19 on people living with HIV, most of the participants mentioned as it affect more in people having chronic disease including HIV.
Participants narrated that they would be severely affected by COVID-19 if they were infected. All most all interviewed participants except one knew the severity of the virus on them. They mentioned that people with low immunity including them were more risky than that of healthy individuals.
“Ehha … I do not tolerate the double burden of the two diseases. I will not cure if two and three virus infects me. When I meet with friends [PLWHA], I worried about the new virus as it kills us before HIV kills us but some people [PLWHV] said “No! No! It [corona] will not kill us”. I said people without HIV can resist corona but I and other people who take drug [ART] will not survive.”40 years female participant
Contexts (factors) related to psychological experience
Personal contexts: knowledge on severity of disease and their immune status; Participants knew that their immunity status lead them for easily susceptibility for COVID-19. Occupational status of participant: merchants always move from place to place due to the nature of their work and this made them to fear of contracting and dying. Barber has many contacts with their customers and this cause to be fear of dying because they are easily at risk for contracting COVID-19.
Familial contexts: low socioeconomic status of the households made them not to stay at home. Participants move here and there to win breads; this made them to be at risk for contracting COVID-19 and faced distressing psychological experiences.
Contexts related to community and governments: lack of psychosocial and financial support, the information heard from the community about the myth and misconception about COVID-19 on people with living with HIV.
theme 2: Social experience
More than half of the study participant faced negative social relation in context of COVID-19 due to their HIV status. Some isolated themselves from social activities and the rest were isolated by others. COVID-19 made them to isolate themselves from participating in social activities like wedding ceremony and funeral ceremony because they worried about the contracting of COVID-19. Two sub themes emerged under this main theme:- Isolating themselves from social activities and and Isolated by others
Isolating themselves from social activities
Participants stated that they had isolated themselves from social activities especially during the initial stage of the pandemic in the country. Restricting themselves in social activities was explored due to fear of contracting the new virus called COVID-19.
“As I tried to explain to you earlier, as soon as corona emerges and distributed throughout the country, we isolated ourselves from social life like absenting from funeral ceremony and people had not good attitude on me because I only know my health status and people do not know the reason why I absent from that social life. I was afraid to go to a place where people gather together” 30 years male participant
Isolated by others
Few of the study participants reported as other people afraid them and they were isolated by others especially during the lock down period. They were assumed by others as they are infected with COVID-19. As a result other people become far away from them and the normal relation that was in pre-COVID-19 was reduced.
“People afraid I because they have information as I am easily susceptible to the disease
and assumed as I have already infected by the disease [COVID-19]. They afraid me and
said be far away from us: living with hearing such type of sayings was difficult for me. So
corona made my social life to be difficult.” A 55 years old male
Amazingly in contrast to the above mentioned study participants, one female participant stated that as her social interaction with her neighbors increased. They assumed them themselves as they will die soon and stop fighting each other.
“Yes before corona we have no good relation as there was (beletishign beletihugsh) type of thinking but after corona everything was changed. We said for this short period of time why we made sinful activities.” A 37 female .
Contexts for social experiences
For the occurrence of these hostile social experiences there were different reasons; these reasons classified as personal, familial and community; participants’ knowledge on the severity of disease on them. Household contexts such as free moving of their family members in everywhere made them to face distressing experiences. Negative perception of community toward PLWHA, traditional activities of the community such as collecting together in traditional activities of the community made some participants to face unsmooth relationships with people.
Theme 3: Economic experience
Majority of the participant had varied experience of economic lose as a result of lockdown and isolation in COVID-19 pandemic.. All participants reported that they were unable to get any financial support from the government and from the community in this COVID-19 pandemic period and their household income was reduced due to COVID-19. Under this two sub-themes were identified 1) disruption of economic activity due to COVID-19 and 2) absence of financial support.
Disruption of economic activity
Some participants brought their concern of significant loss in their business as a result of the closed market. In this study some people on ART reported as they stopped doing their work due to fear of the effect of COVID-19 on them. Two merchant participants express as they stopped shopping because they fear contracting of COVID-19. They mentioned their customers afraid them especially during the lockdown period and do not buy goods and service from them and this led to decrease their household income.
“When corona virus emerges, market was closed at that time I unable to gain money because I stopped working and I stayed at home; in this case the household income decreased in some extent. For example I was buying onion from farmers and selling it to urban residence but the market closed and I unable to gain any profit from the onion and I used the deposited money which was deposited for other purpose. As a result my household economy decreased.” A 25 years old female
“Most of the time I did not work because being hungry is somewhat better than death. I always feared corona because my activities as I told you made me at risk of corona. I stop cashiering and my income decreased.” A 45 years female
.Absence of financial support
Participants stated that people living with HIV including them were economically disadvantaged group of population. But they were not getting any financial support from anybody. The government, community and other social institution were not giving special financial support to people on ART in the study area.
“Only god supports me. I am not getting any special support without God. In the last summer I have got one sack of wheat but this was given to all people [including those without HIV]. I did not gain any special support from anybody in this corona period. Few years back we were going to Debre Tabor and train different things and there was different support for us. But now a day everything is stopped. I have one daughter at home and she did not support me because she is not mature to support me and she did not remember corona. Only God supports me.” A 65 years female
All participants were not gaining any financial support from the government and the community as a result they were living in extreme poverty and the emergency of COVID-19 pandemic made double burden on their financial problem.
Contexts related to economic experience
Government context like lack of concern for people on ART in context of COVID-19 was their main reason for the above experience. Their occupation was the other factors for this distressing experience. Merchant participants experienced decrement household income but civil servants and farmers did not.
Theme 4: ART drug interruption
Four participants explained that they had stopped collecting and taking ART drug though this was for a short period of time at the initial stage of the pandemic in our country (at the lockdown period). As they narrated they were disturbed by the information about the disease (COVID-19) and they considered health institutions were shifted giving routine service including ART to COVID-19 patients. They also feared and stopped going to health institution because they were thinking as there were COVID-19 infected patients in the health center and going and making contact with them was the risk of contracting the virus. As a result they stopped taking ART drugs though this was for short period of time.
“I feared to come to this health center to take my drug as a result I interrupted drug intake for about one week because what I have brought is finished and when corona emerges I fear to go and brought. I assumed the health center was only giving for seriously ill patients and if I go to health center to brought drug, corona will infect me and I stopped coming to this health center.” A 41 years old male participant
But study participants highlighted that due to negative effect of poor ART drug adherence, they were taking ART drug appropriately because ART is a lifesaving medication. They were collecting and taking their medication according to their appointment time even in the lockdown period. They preferred to take their ART medication and desired to continue healthy with HIV.
Contexts: fear of contracting COVID-19 in the health facility, their personal perception about the health institution where they collected drug were factors for their drug interruption. Lack of full information about the routine service of the health center was one an additional reason for their drug intake interruption. Among the sixteen interviewed participants twelve study participants did not interrupted their ART drug and they were taking to increase their immune status. One female study participant reported as she was in intension to stop going and taking the drug during the lockdown period.