**5. Gender and caregivers burden**

African traditional gender norms feminize caregiving and exclude men and boys from caregiving. The normative women roles extend from reproductive role to nurturing infant and sick family members and remain progressive all through their lifetime [40]. However, these roles remain unrecognized except by the beneficiaries. Therefore, personal sacrifice comes with fulfillment of this role, while some female may have to leave school to provide care [41]. The added responsibility may overshadow the individual coping ability and it manifest as stress or burden. Caregiver's burden is defined as an individual response to physical, emotional, psychological, financial as well as social stressors in Ref. to caregiving experience [42]. Burden maybe objective or subjective. Objective burden refers to disruption in household routines, social relations, leisure, time, finances, work as well as physical health which is often observable [43–45]. Subjective burden refers to how the caregiver appraises the caregiving task [44]. However it has been reported that objective burden depends on subjective appraisal of the caregiving task [44]. Report reveals that caregivers of PLWHA experienced high level of burden [34]. With common sessional symptoms and exacerbation in terminal phase of HIV, many are overwhelmed with caregiving demands resulting in burden [46]. Moreover burden may be compounded with lack of support and financial constraint. Studies revealed higher level of both subjective and objective burden among females compared to males [17, 38, 47, 48] and higher level of physical and social burden [49]. But women experienced more objective burden which is often associated with physical task of caregiving [40]. Similarly, another report stated that women are directly involved in providing personal care which is more demanding and significantly contributes to burden [11, 33]. Studies in Nigeria also affirmed a significant relationship between caregiver's burden and gender with 67.5% female accounting for those with high level of caregivers' burden [10, 28]. Similarly, another study in Lagos, Nigeria also affirmed higher level of burden among female and more stressor emanating from financial, physical as well as emotional domain of burden scale.
