Coping strategies of people living with AIDS in face of the disease

ABSTRACT Objective: to identify the coping strategies of people living with aids to face the disease and analyze them according to sociodemographic, clinical and lifestyle variables. Method: this is a cross-sectional quantitative study. The sample consisted of 331 people living with aids treated at an outpatient clinic at a referral hospital for treatment of aids. The Coping Strategies Inventory was used to collect the data. Results: emotion-focused coping modes were more frequently mentioned. The mean scores of women, workers, religious people, and people who never withdrew from the treatment were higher for all factors. Patients who had a partner, who lived with family members and who received treatment support, had higher mean scores in coping, withdrawal and social support factors. As for leisure and the practice of physical exercises, the emotion-focused modes also predominated. A correlation was identified between treatment time, schooling, family income and the factors of the Coping Strategies Inventory of. Conclusion: the study showed that the most frequent coping modes were those focused on emotion.


Method
This is a cross-sectional study with quantitative approach performed at a referral hospital for the treatment of people living with HIV/AIDS in Northeast Brazil.
Without-replacement sampling calculation was based on the total number of patients enrolled in the outpatient clinic of the hospital, constituting a population of 2,350 patients. This population was considered the universe for calculation of the sample.
The formula for finite populations was used and the criteria adopted were a 95% confidence level (Z∞ = 1.96) and sample error of 5%, resulting in a sample size of 331 patients. The adopted selection criteria were: having been clinically diagnosed with aids; age over 18 years; having used antiretroviral therapy for at least 6 months; being registered at the outpatient clinic of the hospital during the data collection period. We To evaluate the coping strategies related to aids and treatment, the study population responded to the Coping Strategies Inventory (CSI) (6) , a checklist with Likert-type scales. The CSI has been translated and validated into the Portuguese language (6) and has confirmed correspondence with the original English version, allowing its use in other studies.
The inventory consists of 8 coping factors, classified as follows: problem-focused coping (factors: confrontation and problem solving), emotion-focused coping (factors: withdrawal, self-care, responsibility acceptance, positive reappraisal and escape-avoidance) and problem-and emotion-focused coping (factor: social support) (6) .  In relation to work, 265 people (80%) reported having some work-related paid activity. Table 1 presents the mean scores, standard deviation, median, and Cronbach's alpha (α) coefficient of each factor.
The internal consistency of the CSI factors, measured by the Cronbach's alpha coefficient, ranged from 0.80 (in the self-control factor) to 0.95 (in the positive reappraisal factor). In this study, there was a greater reference to the coping modes related to the positive reappraisal factor, with a mean score of 1.86, and a lower reference to the coping modes related to the confrontation factor, with a mean score of 0.80.
There was a predominance of emotion-focused coping modes. The scores of comparison of the means of the CSI factors according to sociodemographic variables are presented in Table 2.
The mean scores of women were higher than those of men in all factors and were statistically significant for the factors: confrontation, withdrawal, self-control, responsibility acceptance, escape-avoidance and positive reappraisal.
Elderly people (60 years of age or older) presented higher mean scores on the confrontation, withdrawal and escape-avoidance factors, with predominantly emotion-focused coping modes. Withdrawal, self-control and positive reappraisal were statistically significant.
Concerning occupation, the average scores of people who worked were higher than those who did not work in all factors, being statistically significant for confrontation, withdrawal, self-control, responsibility acceptance, escape-avoidance, and positive reappraisal.
People who reported having a partner had higher mean scores in the confrontation, withdrawal and social support factors than the people who mentioned having no partner. This, the problem-focused and emotionfocused coping modes were similarly presented.
However, only the confrontation, withdrawal and social support factors were statistically significant.
People who reported living with family members had higher mean scores in almost all factors, except for the positive reappraisal factor, than those who reported living alone. Therefore, emotion-focused and problem-focused modes were presented. The following factors were statistically significant: confrontation, withdrawal, self-control, responsibility acceptance, escape-avoidance, and problem solving. People who reported having some treatment support had higher mean scores in all factors than people who did otherwise. There was statistical significance for the factors of withdrawal, responsibility acceptance, problem solving and positive reappraisal.
People who practiced some religion also had higher average scores in all factors compared to nonpractitioners. The statistically significant coping modes were: withdrawal, self-control, and positive reappraisal.
The comparison between mean scores of the CSI factors according to sociodemographic variables showed the predominance of the emotion-focused coping modes. However, the confrontation factor, a coping mode focused on the problem, stood up in all the variables used, besides presenting statistical significance in five of the eight variables.
Comparison scores of the means of the CSI factors according to clinical variables are presented in Table   3 and also show a predominance of emotion-focused modes, and the confronting factor appears in all the variables used.
The highest mean scores related to people without comorbidities were confrontation, withdrawal, self-control, responsibility acceptance and positive reappraisal, with a predominance of emotion-focused modes. However, none of the factors presented statistical significance.
As for CD4 cell counts, higher mean scores were observed for CD4 cell counts > 200 cell/mm 3 only in the confrontation, social support and responsibility acceptance factors; no one factor was statistically significant. In this respect, therefore, the three coping modes were equally observed.
People who never abandoned treatment also had higher mean scores in all factors than those who had done so. Statistical significance was only observed for social support, problem acceptance, and escapeavoidance. for the withdrawal and self-control modes. Therefore,  (Table 5).
In the variables treatment time, schooling, and family income, Spearman correlation indices were significant for comfort, withdrawal, responsibility acceptance, and escape-avoidance, thus predominantly focused on emotion, although the intensity was weak in almost all variables.

Discussion
People living with aids face several stressors related to the chronicity of the disease and/or the ART. In this sense, the application of the CSI (6) was useful to identify how these people face such condition in their daily life.
Coping arises from the idea of overcoming stressors, and in the present study, we identified higher means related to the positive reappraisal, problem solving and escape-avoidance factors, demonstrating the more frequent use of problem-focused and emotion-focused coping methods.
A study of people living with aids identified the use of coping methods focused on positive reappraisal and escape-avoidance factors, thus focused on emotion.
The main coping strategies used were maintaining confidentiality about their seropositive condition, optimism towards treatment, search for social support, rationalization, social comparison, spirituality/religiosity, avoidance and distraction (7) .
In this sense, they used positive reappraisal in Another important aspect of coping with the disease is the job because it can give meaning to people's lives.
One study demonstrated that job constitutes a form of support to positively face the condition of living with aids, as it promotes confidence and self-esteem (12) . In line with this, the present study identified higher mean scores in all factors, as well as statistical significance for almost all factors, among individual who worked, suggesting that they in some way seek to overcome the problems arising from the disease. pointed out in a study as strategies of escape and relief from stress, depression and low self-esteem triggered by the condition of living with aids (10) .
In the present study, Spearman correlation coefficients between the continuous variables (treatment time, schooling and family income) and the CSI factors showed statistical significance for the factors focused on the emotion (withdrawal, responsibility acceptance, and escape-avoidance ), although with weak intensity.
Emotion-Focusing coping can be seen as positive action because when the attitudes of the person living with aids aim to solve the problem arising from the disease, there is a positive confrontation. This happens when confrontation is focused on accepting responsibility since this factor is characterized by attitudes of contribution of the person in the search for knowledge about the disease and by trying to do the right thing (9) .
In this case, optimism is positively associated with psychological well-being and the reduction of stigma associated with aids (18) .
As contributions to the advancement of scientific knowledge, we emphasize that the identification of

Conclusion
The study identified higher means for emotion-