SELF-EFFICACY AMONG PEOPLE LIVING WITH HIV AIDS AFTER COVID-19 PANDEMIC EFIKASI DIRI ORANG DENGAN HIV AIDS PASCA PANDEMI COVID-19

Background: The COVID-19 pandemic has had an impact on all aspects of life, including people living with HIV and AIDS (PLWHA). A high level of self-efficacy in necessary to overcome physical and psychosocial obstacle in PLWHA Objective: This study aims to analyze factors related to self-efficacy in PLWHA after the COVID-19 pandemic. Method: The study was conducted at the Support and Treatment Clinic at the Public Health Center Bogor District using a cross-sectional design. The population is PLWHA at the Clinic. Samples were taken randomly as many as 89 PLWHA. Data were collected using an online questionnaire that had been tested for validity and analyzed multivariate with multiple logistic regression. Result: The results showed that 62,9% of PLWHA had high self-efficacy, 37,1% are less than 35 years old, 74,1% were men, 33% from high education, 35,9% were married, 69,9% had very good knowledge of HIV, 50,5% suffered from HIV less than 7 years, 58,4% had good family support and, 50,5% had good support from Health Care Providers. The long-suffering and healthcare provider’s support are simultaneously related to the self-efficacy of PLWHA after being controlled by age and knowledge (p-value= 0,0001). The most related factor was the long-suffering (p-value=0,010; OR=4,403; 95%CI=1,434-15,518) Conclusion: More than one-third of the respondents still had low self-efficacy and long-suffering is the dominant factor associated with self-efficacy in PLWHA.


INTRODUCTION
Globally, as of July 29, 2022, there have been 572.239.451confirmed cases of Coronavirus Disease (COVID-19), including 6,390,401 deaths, reported by WHO. 1 One of the populations that are vulnerable to contracting COVID-19 is people living with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) (PLWHA).PLWHA has a more severe risk of getting COVID-19 and a risk of death from COVID-19 than people who do not have HIV. 2 The World Health Organization (WHO) shows that nearly 350.000 patients in 38 countries indicated that PLWHA was at increased risk of developing complications and deaths from COVID-19. 3PLWHA is often faced with social factors that are detrimental to health and cause exposure to COVID-19.PLWHA has a 15% greater increase in severity due to COVID-19 and a 38% greater chance of dying in hospitals than the non-PLWHA population.The use of a low Antiretroviral (ARV) or viral load can lower the risk of severity.However, HIV infection remains a risk factor for severity and death regardless of ARV use and low viral load levels. 4e COVID-19 pandemic also gives many barriers to PLWHA.Any local policy of government like a local lockdown policy creates more barriers for patients with chronic diseases such as those living with HIV and interferes with the delivery of effective healthcare and access to HIV treatment. 5In addition, most outpatient facilities were temporarily closed and as a result, new HIV diagnoses, 6 post-exposure prophylaxis, and preexposure prophylaxis fell as health resources were reallocated to combat the COVID-19 pandemic. 7 addition to the risks due to the COVID-19 pandemic, PLWHA is also faced with social and environmental conditions, as well as psychological problems that have an impact on the quality of life of PLWHA, such as changes in social status in the community, loss of work, and lack of psychosocial support from families.Various studies show that most PLWHA has severe levels of stress. 9,10Other studies show the prevalence rate of moderate depression and anxiety in PLWHA ranges from 16.9% and 23%, 11 even suicide attempts in PLWHA are 10.2/1000 people or 100 times the deaths from suicide in the general population, 12 This psychosocial burden can be overcome if PLWHA has good self-efficacy, especially during the COVID-19 pandemic.
Self-efficacy is defined as an individual's effort in the face of a problem or obstacle. 13A high perception of self-efficacy can influence individuals to survive and accept their condition, especially PLWHA.A study showed that PLWHA tends to have low self-efficacy. 14igher self-efficacy is associated with better emotional management and achieving better performance, and vice versa. 15 PLWHA life, high self-efficacy will be able to increase PLWHA awareness of healthy behaviors and adherence to Antiretroviral therapy (ART) and social resilience, which will have an impact on the quality of life of PLWHA. 167][18] This study aims to analyze factors related to self-efficacy in PLWHA after the COVID-19 pandemic.

METHODS
The study used a quantitative approach with a cross-sectional design.Table 2 shows the distribution of respondents' self-efficacy, although it is known that more than half of respondents (62.9%) have high selfefficacy, the percentage of respondents who have low efficacy is still large (37.1%).
Self-efficacy of respondents can be seen from the respondents' beliefs (categories sure and very sure) in their own efforts in treatment (100%), belief in being able to live a normal life (96.6%),confidence in maintaining health to reduce risk and follow doctor's recommendations (96.6%).However, there are still respondents who are unsure, especially in managing emotions, such as feeling sad when facing problems (57.3%),feeling emotional pressure from the people around (78.7%), belief that cannot reduce the side effects of HIV (86.5%), and insecurity to continue taking ARV (74.1%).

DISCUSSION
HIV is a chronic disease that gradually destroys the immune system and eventually causes acquired immunodeficiency syndrome (AIDS).The duration of HIV infection is closely related to the course of the disease and its stages of progression as well as the risk of possible opportunistic infections, such as tuberculosis, pneumonia, and candidiasis.Opportunistic infections (OIs) are infections that occur more frequently or are more severe in PLWHA, which can cause significant health problems and further reduce the quality of life of PLWHA. 19WHA often face challenges both from within themselves and from their surrounding environment, 20 which can pose various physical, emotional, and social challenges. 21he chronic nature of the disease, along with the possible risk of health complications and societal stigma, can lead to anxiety, and feelings of helplessness, which can erode their self-efficacy. 22,23e long-suffering of PLWHA can have a significant impact on their self-efficacy.Selfefficacy is articulated as beliefs about one's ability to organize and execute the actions necessary to manage upcoming situations. 24elf-efficacy is a motivating factor for taking action and one of the four key determinants of health promotion. 13,25People with higher selfefficacy are more likely to engage in health promotion behaviors, including PLWHA.Selfefficacy refers to a person's belief in their ability to successfully accomplish tasks, cope with challenges, and achieve desired outcomes. 26In the context of HIV/AIDS, self-efficacy plays a crucial role in how individuals manage their condition, adhere to treatment, and maintain their overall well-being. 27,28 this study, we found that the percentage of respondents who have low efficacy is more than one-third.Even though the respondent is sure will follow the doctor's advice, the respondent is not sure whether to continue taking an ART.Self-efficacy is an important factor influencing disease management. 18ere are four factors that affect self-efficacy, 13 including 1) Mastery experience (experience in solving problems), associated with stigma and discrimination.This experience seems to increase with age; 29 2) Social modeling, through observation of success in peer groups; 3) Verbal persuasions, such as support from peers, family, and health workers.The role of peer supporters is felt in terms of several aspects including information provision, social support, and treatment; 30 and 4) Physical and emotional conditions, including length of illness. 31e support provided by healthcare providers can have a significant impact on the selfefficacy of PLWHA.Healthcare providers play a crucial role in providing PLWHA with accurate and comprehensive information about their condition, treatment options, and self-care strategies to improve medication adherence.Support from healthcare providers in promoting and assisting with treatment adherence has been linked to higher self-efficacy among PLWHA.When providers offer guidance, reminders, and practical strategies to support medication adherence, patients may feel more confident in their ability to follow their treatment. 32,33 addition to the duration of HIV infection and support from healthcare providers, age and knowledge should also be considered in improving PLWHA's self-efficacy and this should be addressed in intervention efforts.
Age is related to the self-efficacy of PLHIV, as age is associated with different life experiences and maturity levels.middle-aged to older adults seem to be more aware of their disease condition, which affects self-efficacy.Older PLHIV may have accumulated more knowledge and experience over time, which may contribute to higher levels of selfefficacy. 34Although in this study found that age was a confounding factor, and younger people were more likely to have higher self-efficacy, it is important to note that self-efficacy may vary among individuals of different ages, and factors such as health status and the health care system also play an important role.
The same is true for knowledge.Knowledge about HIV/AIDS can affect self-efficacy in PLWHA.Accurate information about their condition and treatment options, will increase their confidence, so they are able to manage their health.
However, this study has limitations in sample size and the possibility of information bias, as data collection using an online questionnaire.In addition, the respondents' knowledge data was also homogeneous with good and very good categories.Nevertheless, the random sampling process and multivariate analysis used are expected to minimize the limitations of this study.

CONCLUSION
Self-efficacy plays a crucial role in how PLWHA navigate their condition, make healthrelated decisions, and maintain their wellbeing.However, more than one-third of the respondents still had low self-efficacy.
PLWHA with long-suffering of less than seven years and good support from health care providers more likely had greater self-efficacy.
In other words, PLWHA with long-suffering for more than seven years and low support from health care providers, has a greater risk of having low self-efficacy, especially if they are more than 35 years old and lack knowledge about HIV.

RECOMMENDATION
Psychosocial interventions from health care providers which can improve self-efficacy are needed, especially for PLWHA who have suffered more than seven years, taking into account the age and knowledge of PLWHA.

Table 1 . Distribution of Characteristics of Respondents and Research Variables
good and poor; self-efficacy was classified as high and low, based on the cut-off points of the average value of each variable.The value of knowledge was quite homogeneous, with the lowest score being 82 and the highest being 100, so we classified it based on the mean value into good and very good.We cannot categorize it as poor, because the score is indeed good.The self-efficacy questionnaire was developed in three domains: self-efficacy for managing stress, managing and adhering to medications, and communicating with healthcare providers.This questionnaire uses the Likert scale (1=very unsure, 2=unsure, 3=sure, 4=very sure).