Poor health care utilization among caregivers dually affected by HIV illness and AIDS orphanhood

Background: There is growing evidence of poor mental health among adults caring for children in HIV-endemic communities. However, we have a limited understanding of whether dually affected caregivers (i.e., those living with HIV while simultaneously caring for a child orphaned by AIDS) face a cumulative risk for anxiety. We also do not fully understand patterns of health care utilization among caregivers most at risk for anxiety. Methods: We conducted a cross-sectional survey from 2009-2010 with 2,477 adult caregivers of children in two HIV-endemic South African communities. Caregiver anxiety symptoms were assessed using the Beck Anxiety Inventory. Multivariate logistic regressions explored whether the relationship between HIV and caregiver anxiety remained after controlling for socio-demographic co-factors. Chi-square was used to assess differences in patterns of health care utilization among caregivers at highest risk for anxiety. Results: A third (30.2%) of caregivers met threshold criteria for moderate or severe anxiety symptoms. The odds of reporting anxiety were ten times greater among dually affected caregivers compared to non-affected caregivers (OR = 10.4, 95% CI = 4.16-26.05, p < 0.001). Dually affected caregivers were significantly less likely to utilize health care services and more likely to seek informal rather than formal health care services. Caregivers most at risk for anxiety reported costs of medical care and transport as barriers to health care utilization. Conclusions: Dually affected caregivers were at highest risk for anxiety. These caregivers were significantly less likely to utilize services, likely due to the inability to pay for medical care or transport.