**3. Women and caregiving**

*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

member returns home for succor.

**2. Women and HIV**

quality of care rendered to the care recipient [10–12].

sheet [6] reveal about 31.6 million–44.5 million (38.0 million) people living with HIV, with about 1.7 new infection in 2019. African disproportionately bear the burden of HIV with about 25.7 million people living with HIV and 470,000 AIDS related death in 2018. Although global effort has been directed to combat HIV impact in Africa, the continent still contributes about two thirds of global new HIV infections with about 1.1 million people infected in 2018 [7]. Nigeria remains Africa's most populous country, with about 1.9 million people living with HIV, 130000 new infection, and 53,000 AIDS-related death in 2018 [6]. The high prevalence of HIV will invariably invoke strain on family life especially when affected

The African nuclear family is a potent therapeutic force, and highly sensitive to the needs of its member, by providing physical, financial, emotional and spiritual support. Studies reveal that family remains the primary entity in caring for individuals, through which socialization, trust, loyalty and inter-family cooperation develops, and many counts on these attributes in adverse health condition [8, 9]. These attributes attracts afflicted members and act as a succor especially during terminal stage of HIV with co-morbidities [9, 10]. Caregiving although a normative role, is assumed most often by people without preparation or questioning even though it may disrupt work, family and social life of the caregivers. As the number of people living with HIV/AIDS increases, the demand for family members who assume caregiving role increases [11]. Moreover without appropriate restructuring of existing role to accommodate new caregiving roles, the increase in responsibility may constitute burden, which is detrimental to the caregiver's health as well as

Women disproportionately bear the burden of HIV and this is often secondary to gender inequalities which are obvious in economic status, cultural and societal norms. Women and girls constitute more than half the population of PLWHA, accounting for 18.8 million prsons. Studies reveal that in every 4 minutes, three young women are infected with HIV with approximately 870,000 new HIV every year among women and girls [13]. Additionally among female age 15–49, AIDSrelated illnesses remains the leading cause of death [14]. Although, no HIV gender disparity existed in children, gender disparities became obvious during adolescence, with girls accounting for 75 per cent (130,000) of new HIV infections among adolescents, globally in comparison to about 44,000 adolescent boys [14]. In sub-Saharan Africa, young women are two times more likely to be infected with HIV than male and they account for 59% of all new HIV infections [6]. Women also disproportionately bear the burden of HIV in Nigeria, among 1,800,000 adults with HIV, and the majority, 1,000,000 (55.56%) were women. New HIV infection among those aged 15–24 years were more (26000) among female compared to 15,000 among their male counterparts [6]. New HIV infections among young women aged 15–24 years were almost double those among young men: 26000 new infections among young women, compared to 15,000 among young men. The high prevalence among female is fueled by biological vulnerability, gender inequalities which encouraged early and forced marriage, lack of information on sexuality, lack of negotiating power as well as economic autonomy [15]. The need to bridge the gap by improving the quality of life of females by encouraging social justice with equal access to employment, education, health services and freedom from discrimination and violence had been advocated as a panacea for ending HIV epidemic by 2030 [4]. In spite of high HIV burden among women, they also bear the brunt of caring for those affected, a double jeopardy.

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It is imperative that as humans navigate through life with changing demographics that some will have to function as caregivers. Caregiving is a role expected of family members however, the irrefutable strength of informal caregiving lies on female family caregivers, whose role are often designated by ideologies and endorsed by culture. It has been asserted that caregiving is feminized and women are socialized into nurturing roles [16]. Studies affirmed that round the world women make-up about 57 to 81% of informal care givers for family members with chronic disabilities [17–21]. Females commenced their caregiving activities at a very young age and maintain this role as they aged [22]. Most often their roles are not recognized by other family members and health care system except by the care recipient [23].

A Canadian study revealed that in every five persons there was a female family caregiver who provided 70 percent or more of required caregiving needs [24]. In the United States, about 41 million family caregivers served 34 billion hours of care to recipient with functional disabilities accounting for an estimated \$470 billion of unpaid caregivers [23]. The female form (65%) majority of family caregivers and about 80% provide care to elderly relative or friend [25]. Another study revealed that 82.8% of family caregivers were females in a study with 583 family caregivers [26]. A similar report was obtained from an Australian research where 2.65 million family caregivers in 2015, were females (12.3%) and only 9.3% were males [27]. Studies in Nigeria also revealed gender difference when it comes to caregiving, where majority were female, (67.3%) and experience a higher level of burden than men [12, 28]. In France majority of caregivers were women and whenever one caregiver was needed to provide care it was most often female [29]. Additionally, daughters form three-quarters of those caring for their elderly parent, and 70% of those caring for their spouses were wives while men tend to seek professional assistance with care duties [29]. Similarly among couples, women most often shoulder caregiving role than their spouses [30]. When it comes to physical care or personal care, such as bathing or getting dressed, women are more likely (19% vs. 8%) than men to provide such care to care recipients [31]. It has been affirmed that caregiving is a traditionally driven activity earmarked for women [32].
