Abstract
AimIn view of the current context of poverty and socio-economic inequalities and the high and rising burdens of HIV infection and non-communicable diseases in South Africa, this study aims to describe the distribution of adverse life events (ALEs) by age and gender, and examine the socio-demographic characteristics, psychosocial coping mechanisms, risky lifestyle behaviours and family burden of HIV-related ill-health associated with ALEs in 25-74-year-old black residents of Cape Town.Materials and methodsIn a random cross-sectional sample, 12 ALEs, tobacco and alcohol use, sense of coherence (SOC), locus of control (LOC) and impact of HIV in the family were determined by administered questionnaires. Data analyses included descriptive statistics adjusted for the realised sample. Multivariable linear regression models assessed the independent associations of increasing number of ALEs.ResultsAmong 1099 participants, mean lifetime score of ALE categories examined was 6.1 ±2.1 (range 0–12) with men reporting significantly higher number of events compared with women (p<0.001). The most frequent ALE was the death of a loved one (88.5%) followed by a major financial crisis (81.2%) with no trend across gender or age group. In the multivariable linear regression model, increasing ALEs were significantly associated with male gender, unemployment, having spent >50% of life in urban areas, >7 years of education, problematic alcohol use and poorer psychosocial coping mechanisms defined by low SOC and LOC. All four variables pertaining to HIV-related burden of ill-health in the family were significantly associated with increasing ALEs.ConclusionsConsidering that lower SOC and LOC and problem drinking were significantly linked to ALEs, policymakers need to formulate strategies that improve coping mechanisms and promote problem-solving behaviours, target the high burden of alcohol misuse and address unemployment.
Highlights
In South Africa, a country emerging from the toxic policies of apartheid that aggressively subjugated most of its population till the introduction of democracy in 1994, the toll of apartheid still resonates today [1]
In a random cross-sectional sample, 12 adverse life events (ALEs), tobacco and alcohol use, sense of coherence (SOC), locus of control (LOC) and impact of HIV in the family were determined by administered questionnaires
In the multivariable linear regression model, increasing ALEs were significantly associated with male gender, unemployment, having spent >50% of life in urban areas, >7 years of education, problematic alcohol use and poorer psychosocial coping mechanisms defined by low SOC and LOC
Summary
In South Africa, a country emerging from the toxic policies of apartheid that aggressively subjugated most of its population till the introduction of democracy in 1994, the toll of apartheid still resonates today [1] It struggles with multiple health-related and socioeconomic ills that are dominated by HIV/AIDS, and high levels of poverty, crime, violence and unemployment. The unscientific health policies pertaining to the HIV epidemic during Thabo Mbeki’s presidency (1999–2008) did nothing to improve the psyche of South Africans This era witnessed a failure to provide antiretroviral therapy to those with HIV/AIDS with the subsequent loss of hundreds of thousands of lives [1, 2]. Despite mortality declining with the introduction of antiretroviral therapy, HIV still accounted for 23.4% of deaths in South Africa in 2019 and almost eight million adults were HIV positive [3]
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