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Gender and Age Differences in Quality of Life and the Impact of Psychopathological Symptoms Among HIV-Infected Patients
Abstract
The purpose of this study was to determine gender and age differences and interaction effects on the quality of life (QoL) domains in a sample of Portuguese HIV-positive patients, and to examine to what degree psychopathological symptoms are associated with QoL in addition to sociodemographic and clinical variables. The sample consisted of 1191 HIV-positive patients, and measures included the WHOQOL-HIV-Bref and the Brief Symptom Inventory. Controlling for clinical status, there was a significant effect of gender on QoL. Women reported lower scores of Psychological and Spirituality QoL. Younger patients reported higher scores on Physical and Level of Independence domains. Age by gender interactions emerged on all domains of QoL except on the Level of Independence domain. Overall, women over 45 years old showed lower QoL scores. Psychopathological symptoms contributed significantly to the variance of all QoL domains. Gender differences in the association of HIV infection with QoL and psychopathological symptoms seemed to be modulated by age. Understanding gender and age differences (and their interaction) may provide potentially useful information for planning interventions to improve QoL and mental health among people infected with HIV/AIDS, especially among older women.
... The concept of QOL is multi-faceted, reflecting different dimensions and experiences in a person's life, such as their psychological, social and physical function. It focuses on assessing functional changes that may occur overtime in various illnesses [2,3]. Measuring QOL and determining associated factors has become important for understanding patients' experiences of living with chronic diseases, and how it affects daily activities [3]. ...
... It focuses on assessing functional changes that may occur overtime in various illnesses [2,3]. Measuring QOL and determining associated factors has become important for understanding patients' experiences of living with chronic diseases, and how it affects daily activities [3]. ...
... Women reported a higher number and severity of adverse events, higher pill burden and lower scores in all three QOL domains compared to men. This is consistent with Pereira et al. 's study which found that the incidence of HIV-related co-morbidities and associated pill burden was higher amongst women [3]. Moreover, the high number of adverse events reported amongst women had an unexpected positive association with Mental QOL scores. ...
Background
Studies which examine quality of life (QOL) provide important insights that are needed to understand the impacts of HIV/AIDS anti-retroviral treatment (ART), comorbid conditions and other factors on the daily activities of people living with HIV/AIDS (PLH). This study aimed to determine the inter-relationships between clinical factors, behavioural, socio-demographic variables and QOL among PLH.
Methods
The secondary analysis used data collected from 293 people living with HIV/AIDS (PLH) receiving second-line ART in Johannesburg in a clinical trial which evaluated the non-inferiority of ritonavir-boosted darunavir (DRV/r 400/100 mg) compared to ritonavir-boosted lopinavir (LPV/r) over a 48 week-period. Physical functioning, cognitive and mental QOL were measured using the Aids Clinical Trial Group questionnaire. Exploratory factor analyses were used to examine the structure, the relationships between and the construct validity of QOL items. Structural equation models which tested the a priori-hypothesised inter-relationships between QOL and other variables were estimated and goodness of fit of the models to the data was assessed.
Results
Patients on darunavir presented with lower pill burden. Older patients and women were more likely to report lower QOL scores. Pill burden mediated the effects of age, sex and treatment regimen on physical functioning QOL and adverse effects; the effects of age, sex, treatment regimen and adverse effects on cognitive QOL; and the effects of sex on mental QOL.
Conclusion
QOL among PLH is associated with socio-demographic and clinical factors. Therefore, QOL could be enhanced by considering PLH characteristics, clinical factors such as regimen side-effects profile, management of comorbid conditions and mitigating risks such as potential adverse drug-to-drug interactions among patients on ART.
... Of the three factors associated to the QoL, the link with the level of education attained leaned towards being universal; almost all the studies we looked at in sub-Saharan Africa (Yaya et al., 2019;Bakiono et al., 2014;Gebremichael et al., 2018;Adewuya et al., 2008) and elsewhere (Nobre et al., 2017;Catalan et al., 2017;Karkashadze et al., 2017;Pereira and Canavarro, 2011;da Silva et al., 2013;Liping et al., 2015;Yang et al., 2016;Passos and Souza, 2015;Castro et al., 2019) reported a positive association between education attained and QoL or equivalently an association between lower education level and lower QoL. ...
... In the current study, being employed was associated to higher QoL scores. Several studies have suggested this association (Nobre et al., 2017;Catalan et al., 2017;Gebremichael et al., 2018;Pereira and Canavarro, 2011;Passos and Souza, 2015), which is more likely to be a reflection of some regular income that elevates the socioeconomic status of the individuals. In the study from Southern Brazil (Pereira and Canavarro, 2011), being of low socio-economic class showed on average lower QoL. ...
... Several studies have suggested this association (Nobre et al., 2017;Catalan et al., 2017;Gebremichael et al., 2018;Pereira and Canavarro, 2011;Passos and Souza, 2015), which is more likely to be a reflection of some regular income that elevates the socioeconomic status of the individuals. In the study from Southern Brazil (Pereira and Canavarro, 2011), being of low socio-economic class showed on average lower QoL. It is also known that employment brings with it several openings into a wider community, relieving therefore some stress or simply providing opportunities to spend time away from the household which is beneficial in many ways. ...
Worldwide coverage of anti-retroviral treatment has extended life expectancy of people living with HIV and AIDS. The expanded survival time brings into play the patients' quality of life, on which little data is available in the Democratic Republic of the Congo. WHOQOL-BREF questionnaire was administered to 249 patients, mostly females (65%), attending a dedicated centre for the treatment and comprehensive support to people living with HIV/AIDS in the city of Lubumbashi and its surroundings. Internal consistency and reliability of the questionnaire were determined using Cronbach's alpha on the contributing 24 items. Descriptive statistics were used: mean and standard deviation for continuous variables and count and percentage for categorical variables. Logistic regression and generalized linear regression models were performed to assess potential association between socio-demographic variables and quality of life. The distribution of the socio-demographic characteristics studied in the current study and their association with the quality of life of people living with HIV/AIDS are comparable with those reported from elsewhere. Consistently, education attainment, employment status, and presence of another HIV positive person in the household manifested as factors associated to the total score, and to all the scores in the six quality of life domains. While further research is warranted in relation to the finding of negative association of the presence of another person living with HIV/AIDS in the household, in order to improve their clients' quality of life, we recommend to service providers the inclusion of psychosocial support that takes into account the individuals' home circumstances.
... Previous research on the relation between gender and HRQoL of PLH had mixed results. Some studies reported that mental HRQoL of male PLH was better than that of female PLH [42], while others generated opposite results [8,13]. Other research showed no apparent correlation between gender and HRQoL [10]. ...
... In this study, older age was associated with lower physical HRQoL. This finding is consistent with reports of other studies [13,42,47,48]. However, age is associated with declining physical health, but not necessarily mental health. ...
... The finding indicates that more service and care should be provided to PLH with left-behind children in the family. The associations between higher income and better HRQoL was supported by many previous studies, as good family economic condition means better living conditions and better health care for PLH [13,42,47,48]. Thus, one of the important mechanisms to improve HRQoL of PLH in rural areas is to carry out effective strategies for poverty alleviation, which need a collaborative effort of the whole society. ...
Background
One of the major challenges faced by people living with HIV (PLH) is the compromised quality of life due to the negative impact of HIV on their health. HIV/AIDS control effort should go beyond laboratory and lay more emphasis on improving the health-related quality of life (HRQoL) for PLH. The objective of this study is to evaluate the physical and mental HRQoL of PLH in rural China, and explore the relationship between HRQoL and individual- and family-level factors.
Methods
A cross-sectional study was conducted among 522 PLH in Anhui, China. Participant’s sociodemographic characteristics, family status, and HIV-related factors were collected. Physical health summary score (PHS) and mental health summary score (MHS) of quality of life were measured. Multiple linear regressions were conducted to estimate the association of the individual- and family-level factors with MHS and PHS.
Results
Male were more likely to report a higher level of PHS and MHS than female (β = 0.123, P = 0.009; β = 0.150, P = 0.002). Age was significantly negatively associated with the PHS (β = − 0.232, P<0.001) when other variables were controlled. Family size remained negatively correlated with PHS (β = − 0.105, P = 0.021). Family annual income was significantly positively associated with PHS and MHS (β = 0.126, P = 0.003; β = 0.135, P = 0.002).
Conclusions
Future intervention should be carefully tailored to the specific needs of sub-populations (such as female and older PLH) considering their physical and mental HRQoL conditions. More attention and care should be provided to PLH with left-behind children in the family.
... In this study, it was unveiled that better social support is a predictor for better HRQoL. This finding was concurrent with other studies across various countries [19,25,27,29,31,32,34,36,53,65]. This is mainly because social support is crucial for adherence to ART drugs which in turn improves the patients' quality of lives [27,29,31,32,34,36,65] though adherence to the treatments and social support are not sufficient to ensure HRQoL. ...
... This finding was concurrent with other studies across various countries [19,25,27,29,31,32,34,36,53,65]. This is mainly because social support is crucial for adherence to ART drugs which in turn improves the patients' quality of lives [27,29,31,32,34,36,65] though adherence to the treatments and social support are not sufficient to ensure HRQoL. ...
... These associations may be attributed to the fact that better educational status and living in urban areas offer a better job opportunity, access to health care, and information. This finding is similar with the existing evidence [28,29,31,32,41,65]. However, these variables as well as the remaining sociodemographic factors (age, religion, ethnicity, and marital status) had no significant effects on other domains of HRQoL. ...
Background . This study examined health-related quality of life and associated factors among HIV positive women receiving antiretroviral therapy in health facilities of Jimma town. Methods. A cross-sectional study was conducted, and consecutive sampling technique was employed to select 377 HIV positive women who were on antiretroviral therapy. Quality of life was measured using WHOQOL-BREF tool. Descriptive statistics, bivariate, and multivariable logistic regression analyses were performed. P values < 0.05 and adjusted odds ratio with 95% of confidence interval were used to determine statistical significance and report associations between the quality of life and independent variables. Results . Among the sampled participants, 344 were interviewed, yielding 91% of response rate. The mean ± standard deviation age of the respondents was 34.07 ± 8.76 years and 80.5% of them were urban dwellers. The proportion of women reporting good health-related quality of life was found to be 46.5%. Specific to each domain, the mean ± standard deviation of level of independence domain was the highest (14.08 ± 3.07) followed by physical (13.46 ± 2.95), social relationships (13.27 ± 3.91), psychological (12.97 ± 2.47), environmental (12.94 ± 3.25), and spiritual (12.39 ± 2.84) domains. Good social support (AOR: 4.99; 95% CI: [2.88, 8.34]), higher wealth status (AOR: 1.85; 95% CI: [1.02, 3.39]), and being on antiretroviral therapy for shorter duration (AOR: 1.85; 95% CI [1.14, 3.03]) were independently associated with better overall health-related quality of life among the participants. Conclusions . The study demonstrated high proportion of HIV positive women on ART had poor health-related quality of life which was affected by wealth index, social support, and duration on antiretroviral therapy.
... Se describe menor score de CVRS asociado a menor nivel de escolaridad (3)(4)(5)(6)(7)(8)(9) , depresión/ansiedad (3,6,(9)(10)(11)(12)(13)(14)(15)(16) , preocupación financiera, falta de soporte económico o social (6,9,10,11,(17)(18)(19)(20)(21)(22) , presencia de síntomas (14,(21)(22)(23) , estigma o preocupación por la confidencialidad (12,17,23,24) , consumo de drogas y alcohol (4,5) , comorbilidades (4,5,25) , bajo nivel de confianza o pobre relacionamiento con el staff médico y menor accesibilidad al sistema de salud (11,17,25) . ...
... En cuanto al género, predominantemente los estudios encuentran peor CVRS entre mujeres en los resultados globales o en algunos dominios de las escalas utilizadas (5)(6)(7)(8)10,11,(14)(15)(16)18,(22)(23)(24)(25)(26)(27)(28)(29) . Mientras que el impacto de la orientación sexual, específicamente hombres que tienen sexo con hombres (HSH), se muestra con resultados variables probablemente por influencia de los diferentes contextos culturales (5,30,31) . ...
... Hallazgos similares han sido reportados en varios estudios internacionales (6,8,10,14,23) . Otros dominios específicos han sido descritos más afectados entre mujeres: psicológico, bienestar físico, de espiritualidad, preocupación por la salud, preocupación por la divulgación y relacionamiento sexual (16,18,23,24) . Varios estudios encuentran que el ser mujer es un factor asociado independiente a peor score de CVRS (6,8,10,11,14,15,24) . ...
Introducción:
aunque existe una mejoría significativa en la sobrevida consecuencia del impacto del tratamiento antirretroviral (TARV), numerosos estudios demuestran que existe una afectación de la calidad de vida relacionada a la salud (CVRS) en personas con virus de inmunodeficiencia humana (VIH).
Objetivo:
evaluar CVRS en personas con VIH y variables socio-demográficas y clínicas asociados, con énfasis en la adherencia al TARV.
Método:
estudio transversal de una muestra no probabilística de personas con VIH, mayores de 18 años, recibiendo TARV, asistidas en el subsector público en un período de 24 meses. Se aplicó la encuesta MOS-HIV SF30 (CVRS). Se aplicó el cuestionario SMAQ para evaluar adherencia.
Resultados:
se incluyeron 101 personas. El cuestionario MOS-HIV SF30 mostró fiabilidad y buena consistencia interna. El score global de CVRS fue 71,71±17,76. Fue peor el score global y en algunas dimensiones en pacientes con carga viral indetectable: funcionamiento físico, p=0,016; energía/fatiga, p=0,008; calidad de vida percibida, p=0,025. En mujeres el score fue peor en dolor, p=0,034; funcionamiento físico, p=0,006; funcionamiento social, p=0,031; salud mental, p=0,040. El score fue significativamente mejor en algunos dominios entre adherentes (salud general percibida, p=0,027; funcionamiento social, p=0,030); en varones gay/bisexuales (dolor, p=0,025; actividad diaria, p=0,028); entre quienes tuvieron relaciones sexuales en el último mes (salud general percibida, p=0,011).
Conclusiones:
el score global de CVRS fue bueno a pesar de ser una población con múltiples vulnerabilidades. Si bien la adherencia se relacionó a mejor percepción de CVRS en algunos dominios, no tuvo impacto en el score global. La carga viral indetectable no fue predictor de mejor CVRS, lo que reafirma que los parámetros biológicos aislados no dan cuenta de la complejidad de la salud percibida.
... The finding that being employed was associated with better QoL is unsurprising. Studies across multiple countries have shown similar findings among PLWHA (Degroote et al., 2013;Pereira & Canavarro, 2011;Rueda et al., 2011;Rüütel, Pisarev, Loit, & Uusküla, 2009;da Silva, Bunn, Bertoni, Neves, & Traebert, 2013). This association is probably bi-directional (Worthington & Krentz, 2005), that is, being employed may be a facilitating factor in promoting social integration and better socioeconomic status, supporting therefore better opportunities in terms of protection, promotion, and maintenance of health and social environments (Calixto & Anaya, 2014). ...
... Although findings have been mixed, ours are consistent with those among PLWHA from various cultures, all indicating that men report better QoL than do women (Chandra, Satyanarayana, Satishchandra, Satish, & Kumar, 2009;Pereira & Canavarro, 2011). These findings are noteworthy as they extend the importance of gender differences in QoL, also in a distinctively egalitarian society such as Finland (Miettinen, Lainiala, & Rotkirch, 2015). ...
... These findings are noteworthy as they extend the importance of gender differences in QoL, also in a distinctively egalitarian society such as Finland (Miettinen, Lainiala, & Rotkirch, 2015). Our findings also indicate that living with a partner is associated with better QoL, as previously reported (Briongos Figuero, Luque, Martin, Sagrado, & Bouza, 2011;Degroote et al., 2013), particularly in the domain of social relationships (Pereira & Canavarro, 2011). This finding reinforces the importance of intimate relationships, which serve as a key source of social and emotional support, and therefore affect positively individuals' QoL (Han, Park, Kim, Kim, & Park, 2014). ...
In recent years, the concept of quality of life (QoL) has received significant attention in the HIV/AIDS literature. In Finland, however, the factors associated with the QoL of people living with HIV/AIDS (PLWHA) still remain unknown. The aim of this study was to identify the sociodemographic and HIV-related factors associated with the different domains of QoL of PLWHA in Finland. The sample of this cross-sectional study consisted of 453 HIV-infected patients (Mean age = 46.5 years; 76.5% male) followed at the Infectious Disease Clinic of Helsinki University Hospital. Participants completed a self-reported questionnaire covering sociodemographic and HIV-related information, and the Finnish version of the WHOQOL-HIV-Bref questionnaire. Participants reported rather high scores in the six QoL domains, which ranged between 68.48 (Social relationships) and 78.05 (Environment) on a 0–100 scale. Multiple regression analyses revealed that male gender, being married or living in a partnered relationship, being employed, having fewer financial concerns, and not having depression and other medical comorbidities were the main factors positively and consistently associated with higher scores in the different domains of the QoL. HIV-related variables were not significantly associated with QoL ratings. Sociodemographic factors were independently associated with the QoL of PLWHA in Finland. Psychosocial support should reflect these factors in order to improve the health status and well-being of PLWHA.
... Furthermore, consistent with findings in Abadan, our study accentuated a positive association between higher socioeconomic status and elevated scores across all QOL domains among WLHIV [36]. Echoing these sentiments, corroborative evidence from Brazil, Uganda, and Congo further substantiates the observed relationships, positing that low-socioeconomic status among women is intrinsically linked to heightened economic challenges impacting survival aspects, including housing, sustenance, and access to health-related services [37][38][39][40]. Crucial determinants such as marital status and the educational background of WLHIV and their spouses surfaced as directly and significantly associated with QOL. ...
... Harmonizing with pertinent literature, the present study demonstrated a direct and significant association between all domains of social support and QOL [40,41]. A noteworthy dichotomy emerged in the nuanced association between social support and QOL concerning gender, with men displaying significant associations with both mental and physical domains, whereas women exhibited an association limited to the mental domain. ...
We aimed to assess psychosocial predictors of quality of life (QOL) among women living with HIV/AIDS (WLHIV). QOL has been considered as an important indicator in evaluating the outcome of psychological and physical healthcare in people living with HIV (PLHIV).
This cross-sectional study was carried out from October 2021 to April 2022 at the Voluntary, Counselling, and Testing (VCT) center in Shiraz, Iran. A total of 452 WLHIV were included in this study. Socio-demographic and clinical data, social support (MSPSS questionnaire), food insecurity (HFIAS questionnaire), resilience (CD-RISC questionnaire), mental health status (DASS questionnaire), and QOL (WHOQOL-BREF questionnaire) were collected through direct interviews and patients' files at Shiraz VCT.
Physical and social relationships domains of QOL had the highest (60.48 ± 18.00) and lowest (36.76 ± 23.88) scores, respectively. Higher clinical stage, psychotropic substances use, having a husband infected with HIV, history of hypertension, and higher socioeconomic status had a significant relationship with some domains of QOL. The score of social support, food insecurity, resilience, and mental health status had a significant relationship with all domains of QOL.
Social relationships domain of QOL had the lowest scores in WLHIV. Also, the mental health status of WLHIV was more related to their QOL than the physical status related to HIV/AIDS. Interventions such as improving the mental health care and resilience skills of WLHIV, including their social network in counseling services to promote their social support, could help them to improve their QOL.
... The quality of life is a significant concern for PLHIV, and multiple studies have indicated a decline in quality of life as individuals age, primarily attributed to age-related physical deterioration. [17]. Compared to younger people, older PLHIV report less independence and lower levels of physical fitness [17]. ...
... [17]. Compared to younger people, older PLHIV report less independence and lower levels of physical fitness [17]. The reduced ability of older people to metabolize antiretrovirals (ARVs) may cause higher toxicity [18]. ...
Owing to the advent of antiretroviral (ART) drugs, human immunodeficiency virus (HIV) has become a controllable infection, but pernicious health outcomes due to the infection are inevitable. Older people living with HIV (PLHIV) may face more problems than younger PLHIV, such as financial constraints, physical strength, and adaptability. Cardiovascular diseases (CVDs) are a major group of age-related disorders. A plethora of studies have reported the contribution of HIV to the development of various CVDs. Furthermore, the risk of CVD in the geriatric HIV population is higher than in the younger population. CVDs can be attributed to several risk factors, including immune dysfunction, damage to the endothelial cells lining blood vessels, abnormal lipid levels, high blood pressure, obesity, diabetes, smoking, excessive alcohol consumption, sleep disorders, persistent inflammation, compromised immune function, and the use of ART in PLHIV. Despite the availability of data on CVD risk in the general population, the knowledge gap regarding the risk of CVD in geriatric PLHIV requires further exploration. Furthermore, the key strategies to overcome the risk of CVD in geriatrics are lifestyle changes and dietary management, followed by the selection of appropriate antiretroviral drugs and statins for the treatment of elderly PLHIV. This narrative review briefly discusses the epidemiology, risk factors, mechanisms, and CVD risk in older PLHIV, and strategies to overcome them.
... Older survivors with AIDS are often vulnerable to PTSD [15] and other adverse mental health outcomes, such as depression and dementia, including Alzheimer's disease [14]. Quality of life decreases with age for them, due to their age-related physical declines and their poorer emotional well-being [16]. These psychological impacts can accumulate and increase their risks of poor mental health and premature death [17]. ...
... The finding that older survivors suffered less stigma, aloneness, and sadness compared to the younger men or to women differs from other studies that have highlighted the extreme vulnerability of AIDS long-term survivors [16,35]. The stigma suffered by people with AIDS is well-documented and those who are older can endure additional ageist exclusion and rejection, feeling more isolated and less supported than younger people with AIDS [36,37]. ...
Long-term HIV/AIDS survivors responded online concerning their experiences during the AIDS and COVID pandemics. Recruited from web-based organizations for AIDS survivors, 147 answered questions on: frequency of experiencing stigma, isolation, aloneness, or grief/sadness; pet ownership; and sources of human support during each pandemic. Conditional inference trees were run to identify relevant demographic factors. Post-hoc comparisons were conducted to compare dog owners and cat owners. AIDS survivors reported more frequent feelings of stigma, aloneness, and sadness/grief during the AIDS pandemic than during COVID. Cat owners’ sadness/grief during AIDS was greater than non-owners. During COVID, older respondents unexpectedly were less often sad/grieving than younger ones; dog owners less often felt alone and isolated than non-dog owners. Support during the AIDS pandemic retrospectively was rated better for older respondents; young gays’ support was greater than young straights. During COVID, support was better for men than women. Contrastingly, women with pets felt less support than those without; men with dogs felt more support than those without. Cat owners more often felt isolated and unsupported during COVID than dog owners. Few dog or cat owners received support from family members in either pandemic; during AIDS, family support was better for owners of dogs than cats.
... 76,77,87 Furthermore, people ageing with HIV seemed to have developed adaptative coping strategies, a positive self-concept, good emotional status, meaning in life, positive attitudes towards the future, resilience, social support, and productive interactions with health-care professionals. 59,81,[88][89][90][91] In the ASTRA study in the UK, the prevalence of depression and anxiety in people with HIV tended to decrease with age, and the prevalence of functional problems tended to increase; however, rather than age, it was found that the duration of HIV infection influenced the physical and mental health of older people with HIV. 14 Other studies found that a longer time since HIV diagnosis was strongly associated with a higher prevalence of depression, anxiety, symptom distress, and functional problems, 92 and decreased HRQOL. 59,77 In the ANRS-VESPA2 study, the authors sought to disentangle the complex relationships between diagnosis-specific cohort effects and age effects, and reported significant associations with age for all outcomes. ...
... 79 Women in Portugal reported agerelated declines in the physical, psychological, and environmental HRQOL domains more frequently than did men. 92 Among women with HIV aged 45-60 years from England, high levels of poverty, psychological distress, and social isolation were observed, particularly in Black African women. 93 The prevalence of psychiatric diagnoses in HIV-positive women aged 50 years or older was higher than that in HIV-positive men of the same age range in Germany. ...
People ageing with HIV face crucial challenges that can compromise their long-term health, one of which is stigma. HIV-related stigma can interact with other coexistent inequities to create a unique oppression system that results in traumatic experiences. This intersectionality of stigmas represents a new inequality that is greater than the sum of the original component inequalities. In this Series paper we review the literature regarding the intersectionality of HIV-related and ageing-related stigma and health-related quality of life among people ageing with HIV in China, Europe, and Latin America—three regions that represent distinct epidemiological and cultural trends in terms of HIV and ageing. Substantial gaps in the literature were identified, in particular a scarcity of data from Latin America. We also found inconsistencies between countries in terms of definitions and reporting practices related to people ageing with HIV. Research that fully considers the intersectional stigmas faced by this vulnerable population will contribute to advancing the United Nations 2030 Agenda for Sustainable Development.
... Sesuai hasil penelitian lain bahwa ada pengaruh signifikan jenis kelamin pada kualitas hidup. Wanita melaporkan skor Psikologis dan Spiritualitas QoL yang lebih rendah [15] [16]. Perempuan dalam menggunakan stressor pun lebih menggunakan perasaan dibanding laki-laki, sehingga saat pasien wanita di diagnosa HIV, menjalani pengobatan dalam jangka waktu lama, mengalami komplikasi gejala, atau mendapat tekanan social dari masyarakat sekitar akan berpengaruh terhadap status psikologinya. ...
... Iva Gamar Dian Pratiwi / Factors Affecting The Quality Of People With HIV / AIDS (PLWHA) Undergoing ARV Therapy domain kualitas hidup. Perbedaan Jenis kelamin ODHA pun dalam hubungannya dengan kualitas hidup juga sebagian dipengaruhi oleh usia, yang tampak dari gejala psikopatologis, dengan memahami perbedaan jenis kelamin dan usia yang tergambar dari gejala psikopatologis maka dapat memberikan informasi yang sangat penting untuk merencanakan asuhan yang tepat dalam meningkatkan kualitas hidup ODHA[15].Hasil penelitian ini menunjukkan bahwa reponden ODHA wanita paling sedikit memiliki kualitas hidup baik yaitu hanya 14.3%. Penulis berpendapat bahwa hal tersebut bukan hal yang mengherankan lagi jika memang terjadi di Kabupaten Sumenep, karena jika dilihat dari segi kebudayaan suku Madura masih sangat kental dengan kebudayaan dan kearifan lokalnya, dimana wanita masih berada pada posisi subordinat. ...
The incidence of HIV / AIDS is still high and is still described as an iceberg phenomenon. This condition forces PLWHA to always feel worried about their lives because they are threatened with death. The problems of PLWHA in Sumenep Regency are very complex, starting from the quality of life, stigma against PLWHA, transmission, treatment, to PLWHA, which until now have not been detected, coupled with the cultural atmosphere of the Madurese community, especially Sumenep Regency. This study aims to determine the factors that affect the quality of life of PLWHA undergoing ARV therapy. This type of research uses a survey design and is a quantitative study. The study population was all PLHIV patients who were actively using ARV therapy in Sumenep Regency, with a total sample of 56 respondents. Purposive sampling is used as a sampling technique. The independent variables in this study were socio-demographic factors (marital status, gender, age, education, occupation), medication adherence, duration of ARV therapy and stigma. The dependent variable is the quality of life. Chi-square test was used to test bivariate analysis and path analysis with the help of AMOS software was used to test multivariate analysis. The research location is in Sumenep Regency, namely in four Puskesmas which are used as ARV drinking facilities. In this study, it was found that the variable data that had the most influence on the quality of life was gender with a Nilai p of 0.055 which was smaller than α (0.1). The cross-tabulation analysis showed that female ODHA respondents had at least a good quality of life, namely only 14.3%. This is not surprising if this happens in Sumenep Regency, because from a cultural perspective, the Madurese are still very thick with their culture and local wisdom, where women are still in a subordinative position. Women with HIV / AIDS will be stigmatized and excluded from society.
... The findings are in line with those of previous research by Liping, Peng, Haijiang, Lahong & Fan (2015) they reported that young patients have better quality of life. Pereira & Canavarro (2011);Han, Park, Kim, Kim, & Park (2014) also exposed that age influences quality of life. It is also divulged that older patients have lower, (Razavi et al., 2012); moderate (Astina, Ahmad, & Budiyanto, 2015), and worse quality of life than younger one (Hays et al., 2000). ...
... The findings are in line with those of previous research by Liping, Peng, Haijiang, Lahong & Fan (2015) they reported that young patients have better quality of life. Pereira & Canavarro (2011); Han, Park, Kim, Kim, & Park (2014) also exposed that age influences quality of life. It is also divulged that older patients have lower, (Razavi et al., 2012); moderate (Astina, Ahmad, & Budiyanto, 2015), and worse quality of life than younger one (Hays et al., 2000). ...
Background:
The cardinal aim of the present study was to assess the level of social support, self esteem and quality of life among people living with HIV/AIDS in Jammu and Kashmir State of India. Further, the study strived to explore the relationship between independent and dependent variables.
Method:
The study consists a sample of 460 AIDS patients selected through purposive sampling technique, out of them 177 (38.3%) were male, 283 (61.5%) were female patients; 295 (64.1%) were married and 165 (35.9%) were unmarried. Measures included Enriched Social Support Inventory by Mitchell et al., (2003), Rosenberg's Self-Esteem Scale (1965) and Quality of Life Scale by Sharma & Nasreen (2014). For the statistical analysis of data Mean, Standard deviation, Frequency distribution, t-test, one way analysis of variance, eta square, correlation analysis and Scheffe’s post hoc test was applied by SPSS 20.0 version.
Findings:
The findings illustrated that majority of patients have poor social support, lower self-esteem and poor quality of life; also it reveals that patient’s social support, and self-esteem differs by age, occupation, duration of illness, gender, and marital status. However their quality of life differs only by their age, occupation, duration of illness, and marital status. Further the result shows social support and self-esteem are positively correlated with quality of life.
... The findings are in line with those of previous research by Liping, Peng, Haijiang, Lahong & Fan (2015) they reported that young patients have better quality of life. Pereira & Canavarro (2011);Han, Park, Kim, Kim, & Park (2014) also exposed that age influences quality of life. It is also divulged that older patients have lower, (Razavi et al., 2012); moderate (Astina, Ahmad, & Budiyanto, 2015), and worse quality of life than younger one (Hays et al., 2000). ...
... The findings are in line with those of previous research by Liping, Peng, Haijiang, Lahong & Fan (2015) they reported that young patients have better quality of life. Pereira & Canavarro (2011); Han, Park, Kim, Kim, & Park (2014) also exposed that age influences quality of life. It is also divulged that older patients have lower, (Razavi et al., 2012); moderate (Astina, Ahmad, & Budiyanto, 2015), and worse quality of life than younger one (Hays et al., 2000). ...
Background: The cardinal aim of the present study was to assess the level of social support, self esteem and quality of life among people living with HIV/AIDS in Jammu and Kashmir State of India. Further, the study strived to explore the relationship between independent and dependent variables. Method: The study consists a sample of 460 AIDS patients selected through purposive sampling technique, out of them 177 (38.3%) were male, 283 (61.5%) were female patients; 295 (64.1%) were married and 165 (35.9%) were unmarried. Measures included Enriched Social Support Inventory by Mitchell et al., (2003), Rosenberg's Self-Esteem Scale (1965) and Quality of Life Scale by Sharma & Nasreen (2014). For the statistical analysis of data Mean, Standard deviation, Frequency distribution, t-test, one way analysis of variance, correlation analysis and Scheffe’s post hoc test was applied by SPSS 20.0 version. Findings: The findings illustrated that majority of patients have poor social support, lower self-esteem and poor quality of life; also it reveals that patient’s social support, and self-esteem differs by age, occupation, duration of illness, gender, and marital status. However their quality of life differs only by their age, occupation, duration of illness, and marital status. Further the result shows social support and self-esteem are positively correlated with quality of life.
... Gender influence should be reviewed through factors already identified in HRQOL in PLWHA, such as emotional disturbance, self-esteem, coping strategies, social support and stigma. A higher prevalence of emotional disturbance and distress among women has been reported (Gordillo et al., 2009;Pereira & Canavarro, 2011;Sherr et al., 2012;Turner, Laine, Cosler, & Hauck, 2003;Valverde et al., 2007;Wisniewski et al., 2005). Regarding self-esteem, some studies say that it is higher among men (Kling, Hyde, Showersy, & Buswell, 1999), whilst some did not find significant gender differences (Reilly & Woo, 2004). ...
... We hypothesized that men and women living with HIV infection would show differences in their HRQOL, and that women would report worse physical and mental HRQOL than men. According to our results, women exhibited more emotional distress and negative mood related to their HIV condition, were less satisfied with their body image, used less positive coping strategies and experienced more rejection and stigma than men, which coincides with previous findings (Gordillo et al., 2009;Pereira & Canavarro, 2011;Sherr et al., 2012;Tarakeshwar et al., 2005;Turner et al., 2003;Valverde et al., 2007;Wisniewski et al., 2005). Women also reported higher levels of pain, less energy and worse physical and mental health in the MOS-HIV questionnaire. ...
Studies exploring gender differences in health-related quality of life (HRQOL) of people living with HIV/AIDS (PLWHA) are scarce and contradictory. This study evaluated gender differences in HRQOL of 744 PLWHA with median (IQR) age 44 (37–48) years and HIV infection diagnosed 12 (5–20) years earlier. Results showed important differences between genders (p < .05). Better male physical health was related to being employed, not having economic worries, not receiving psychological support, not having injected drugs in past, low negative mood HIV-related, low HIV illness representation and internalized stigma, and high body image satisfaction and health behavior. For women, variables were fewer years since HIV diagnosis and low enacted stigma-personal experience of rejection. Mentally, variables in men were being employed, not having injected drugs, having a stable partner, high health behavior, use of problem-solving coping, personal autonomy and personal meaning. In women, better mental health was related to high CD4 cells, self-esteem and body image satisfaction, and negative mood HIV-related. Men and women coincided in absence of past opportunistic infections being related to better physical and mental health, and absence of side effects for physical health and low HIV-related stress and HIV illness representation for mental health. Our results highlight the need for detailed study of gender differences that identify the bio-psycho-socio inequalities that affect HRQOL.
https://doi.org/10.1080/09540121.2019.1597959
... Studies often examine older PLWH as one homogenous cohort, yet the classification of "older" may benefit from closer examination. Traditionally, older adults with HIV have been considered to be those ages 50 and older, and studies have shown that quality of life decreases with age in this population (Cahill & Valadéz, 2013;Pereira & Canavarro, 2011). Research has also suggested that there may be meaningful differences between PLWH in their 50s as compared to those in their 60s (Lima et al., 2007;Vance, Mugavero, Willig, Raper, & Saag, 2011). ...
... To our knowledge, this is the first study of its kind examining the relationships between affective states, social support, and alcohol use within distinct cohorts of older adults living with HIV. Understanding these differences provides salient information for interventions attempting to improve health for older PLWH (Pereira & Canavarro, 2011). Our results suggest that interventions should target negative affective states in younger HIV-infected older adults, and preserve social support for HIV-infected adults as they age, as this will likely improve the general health of this population as well as specifically decrease deleterious alcohol consumption. ...
We examined the influence of age on associations between affective states, social support, and alcohol use by age cohorts. We recruited 96 older Black adults living with HIV from the southeastern United States in 2013 and 2014. Participants completed questionnaires assessing demographics, psychological function, and substance use. Hierarchical regression analyses assessed the relationship between psychosocial factors and alcohol use in a 50- to 59-year-old group, and a 60 years and older age group. After controlling for covariates, trait anger, state anger, and life stress were positively associated with alcohol consumption in the younger group, while social support was negatively associated with alcohol consumption in the older group. Interventions should target negative affective states in 50- to 59-year-old adults with HIV, and preserve social support for adults with HIV as they age, as such interventions will likely have an impact on these individuals’ alcohol consumption and longstanding quality of life.
... There is evidence suggesting that co-infected patients report significantly more psychological symptoms than HIV mono-infected patients particularly somatic (Baum et al., 2008;Hilsabeck et al., 2003) and depressive symptoms (Baum et al., 2008;Braitstein et al., 2005;Gillis et al., 2013;Pantalone et al., 2012;Yoon et al., 2011). Also, it has been shown that patients with higher levels of psychological distress exhibit reduced QoL, and strong negative associations between symptoms of psychological distress and QoL have been reported in HIV (Pereira & Canavarro, 2011;Préau et al., 2007a), HCV (Fontana et al., 2002;Hauser et al., 2004) and HIV/HCV (Marcellin et al., 2007;Pereira et al., 2014). ...
... Besides psychological symptoms, across multiple samples of HIV-infected patients, QoL has been associated with several sociodemographic and clinical variables. Although many studies have reported mixed findings, there is some consistency regarding the associations between poorer QoL and female gender (Chandra et al., 2009;Degroote et al., 2013;Pereira & Canavarro, 2011), older age Préau et al., 2007b;Skevington, 2012), living alone or not having a stable partner (Degroote et al., 2013;Préau et al., 2007b), lower education (da Silva et al., 2013;Liu et al., 2006), unemployment or lack of work activity (Fleming et al., 2004;Liu et al., 2006;Rueda et al., 2011), and IDU (Degroote et al., 2013;Préau et al., 2007b). Regarding clinical variables, lower CD4+ T cell (CD4 for short) count (Canavarro & Pereira, 2012;Hays et al., 2000;Safren et al., 2012), and advanced HIV stages Ruiz Perez et al., 2005;Zimpel & Fleck, 2014) have also been associated with lower QoL. ...
This study compared the quality of life (QoL) of HIV-infected patients with and without hepatitis C and examined the sociodemographic, HIV-related and psychological symptoms associated with the QoL domains in patients with HIV/HCV co-infection. The sample consisted of 248 HIV/HCV co-infected patients (18–74 years, 81.5 % male) and 482 patients only with HIV (24–78 years, 62.7 % male). Participants completed the WHOQOL-HIV-Bref questionnaire and the Brief Symptom Inventory. The HIV/HCV co-infected patients reported significantly lower QoL in all domains, as well as significantly lower scores in 10 of the 17 specific facets. Overall, among the co-infected patients, male gender, employment, combination antiretroviral therapy use and fewer depressive and anxiety symptoms were significantly associated with higher QoL. Symptoms of psychological distress accounted for significant variability in the QoL scores of co-infected patients. These data reinforce the need for tailored interventions to improve the overall well-being of HIV/HCV co-infected patients.
... Cronbach's α reliability for this questionnaire in the current study was 0.82, 0.88, 0.86, and 0.86 at T1, T2, T3, and T4, respectively. at baseline as covariates, as they may be related to main study variables [66][67][68]. Model fit was assessed using the ratio of chi-squared (χ 2 ) to the degree of freedom, comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and standard root mean square residual (SRMR). For an index to be acceptable, the ratio of χ 2 to the degree of freedom should not exceed 5.0, TLI and CFI should exceed 0.90, SRMR and RMSEA should be smaller than 0.08 [69]. ...
Depression is one of the most common mental health problems among people living with HIV (PLWH). However, the longitudinal psychological mechanism underlying the link of internalized HIV stigma and depressive symptoms remains a research gap. This study attempted to articulate how and to what extent perceived social support and resilience mediate the longitudinal associations between internalized HIV stigma and depressive symptoms. A sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval and four waves of follow-up was used in the current study. Participants were asked to complete self-report questionnaires. The associations among main study variables were examined via a complete longitudinal mediation approach. Results indicated that the linkage between internalized HIV stigma at T1 and depressive symptoms at T4 was serially mediated by perceived social support at T2 and resilience at T3, and perceived social support at T2 and depressive symptoms at T3 serially mediated the relationship between resilience at T1 and internalized HIV stigma at T4. Depressive symptoms at a previous time point consistently predicted the levels of internalized HIV stigma at subsequent time points. The study highlights the complex interplay between internalized HIV stigma, mental health problems, and protective factors in a longitudinal context. The findings suggest the need to incorporate interventions aimed at enhancing social support and resilience in mental health programs for PLWH, as these factors may interrupt the pathway from internalized HIV stigma to depressive symptoms and potentially improve the overall psychological well-being of this population.
... However, only a steady marital and stable family life provides the necessary emotional and social backing to PLWHA and higher HRQoL compared to those staying alone, divorced, separated, or widowed. [12,24,25] In addition, the presence of comorbidity/comorbidities negatively affect the quality of life as compared to those with no comorbidity. [17,24,26] Our study shows that the majority of our respondents had well accepted their disease status leading to a satisfactory health status in 85.2% and good HRQoL in 74.8% of cases. ...
Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them.
Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization's Quality of Life‒HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying).
Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years (mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson's Chi-squared test showed no statistically significant (P > α) associations between good HRQoL and variables such as age >40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for >3 years, and CD4 >200 cells/mL.
Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.
... Compared to the traditional cross-lagged panel model (CLPM), which only considers the between-person component, RI-CLPM is viewed as promising for longitudinal analyses since it can consider both levels of variance (i.e., between-and within-person levels) and provide a more comprehensive understanding of the association between variables over time. We also included age, gender, and monthly income as covariates in the RI-CLPM because they may be associated with key variables in this study [48][49][50]. The RI-CLPM was employed on the structural equation modeling. ...
Previous research has documented that HIV-related stigma (e.g., internalized and anticipated stigma) is detrimental to the mental health of people living with HIV (PLWH). However, longitudinal data on the bidirectional relationship between HIV-related stigma and depression symptoms are limited. The purpose of this study was to examine the bidirectional association among internalized and anticipated HIV stigma and depression symptoms among Chinese PLWH. A four-wave longitudinal design (6 months intervals) was employed among 1,111 Chinese PLWH (Mage = 38.58, SD = 9.16, age range: 18–60 years; 64.1% men). The bidirectional model was examined using a random-intercept cross-lagged panel model (RI-CLPM), which evaluated the within- and between-person effects of study variables. At the within-person level, results indicated that depression symptoms at T2 mediated the linkage between internalized HIV stigma at T1 and anticipated HIV stigma at T3, and that anticipated HIV stigma at both T2 and T3 mediated the relationship between depression symptoms at the previous time point and internalized HIV stigma at the subsequent time point. Furthermore, a bidirectional association was found between anticipated HIV stigma and depression symptoms across four waves. At the between-person level, internalized and anticipated HIV stigma were significantly associated with depression symptoms. This study highlights the complex interplay between different forms of HIV-related stigma and mental health problems among PLWH and underscores the importance of considering the bidirectional relationship between the development of psychopathology and stigmatization process in clinical practice.
... This inverse association between age and physical health observed in the present study is in line with the findings of a previous review [40]. In a study with 1191 HIV-positive patients, participants aged over 45 years reported lower scores on the physical domain of the HRQOL than did those aged under 34 years [52]. Relatedly, a previous study found that nearly half of older people with HIV had at least one major medical comorbidity, and a greater burden of co-morbidity was associated with a lower physical HRQOL [53]. ...
... Comorbid conditions have been noted as a challenge for those aging with HIV.17,19,31,127,128 After accounting for other factors, women in our sample reported lower QOL, in line with other studies.40,124,129 Finally, after accounting for other factors, we found those who were married or had long-term partners reported lower QOL, more depressive symptoms, and higher stress. ...
Purpose
Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population—especially modifiable factors—could inform future interventions.
Methods
Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions.
Findings
Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress.
Conclusions
In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.
... 47,52 Likewise, older PLWH report lower levels of physical ability and less independence compared with younger people. 53 Furthermore, disability among older PLWH is predictive of worsening mobility or disability in ADL. 54 ...
Despite advances in knowledge about older people living with HIV infection (PLWH), frailty remains a challenge to HIV care. Numerous studies have documented its impact; however, the concept remains unclear. Concept exploration of frailty in the context of older PLWH was conducted to provide a comprehensive understanding of the concept based on the Walker and Avant method. After the literature review, a concept analysis and a definition of frailty among older PLWH emerged. Implications for further practice, education, public policy, and research are presented to use the concept consistently, develop interventions to prevent frailty, and improve health outcomes.
... In general, females are the most marginalized population, perhaps due to the high stigma and discrimination against them in Pakistan [56]. It can, therefore, be inferred that gender is a significant social determinant of health and that variations between gender-related HRQoL factors need to be addressed [57]. The current study found that the average HRQoL score of singles was more than married and widowed patients, which is consistent with the evidence from a previous study conducted in Ethiopia [58]. ...
Background
Health-related quality of life (HRQoL) is considered to be the fourth 90 of UNAIDS 90-90-90 target to monitor the effects of combination antiretroviral therapy (ART). ART has significantly increased the life expectancy of people living with HIV/AIDS (PLWHA). However, the impact of chronic infection on HRQoL remains unclear, while factors influencing the HRQoL may vary from one country to another. The current study aimed to assess HRQoL and its associated factors among PLWHA receiving ART in Pakistan.
Methods
A cross-sectional descriptive study was conducted among PLWHA attending an ART centre of a tertiary care hospital in Islamabad, Pakistan. HRQoL was assessed using a validated Urdu version of EuroQol 5 dimensions 3 level (EQ-5D-3L) and its Visual Analogue Scale (EQ-VAS).
Results
Of the 602 patients included in the analyses, 59.5% ( n = 358) reported no impairment in self-care, while 63.1% ( n = 380) were extremely anxious/depressed. The overall mean EQ-5D utility score and visual analogue scale (EQ-VAS) score were 0.388 (SD: 0.41) and 66.20 (SD: 17.22), respectively. Multivariate linear regression analysis revealed that the factors significantly associated with HRQoL were: female gender; age > 50 years; having primary and secondary education; > 1 year since HIV diagnosis; HIV serostatus AIDS-converted; higher CD 4 T lymphocytes count; detectable viral load; and increased time to ART.
Conclusions
The current findings have shown that PLWHA in Pakistan adherent to ART had a good overall HRQoL, though with significantly higher depression. Some of the factors identified are amenable to institution-based interventions while mitigating depression to enhance the HRQoL of PLWHA in Pakistan. The HRQoL determined in this study could be useful for future economic evaluation studies for ART and in designing future interventions.
... 10,43 That is because a stable family life provides the necessary emotional and social backing to PLWHA. 53 Nonetheless, there have also been conflicting reports where patients who are living with a spouse or partner had a much poorer HRQoL than those who remained single. 54,55 However, our research found that intimate relationships are essential for a better quality of life. ...
Introduction:
Diagnosis of HIV/AIDS infection can have adverse effects on the individual and may affect health-related quality of life (HRQoL). Numerous studies have previously assessed the HRQoL of persons living with HIV/AIDS (PLWHA) globally, but not in Jordan. The aim of the current study is to examine HRQoL among PLWHA residing in Jordan and to evaluate the effect of socio-demographic and disease-related factors on HRQoL.
Methodology:
An exploratory approach employing a cross-sectional design was applied. The study applied a semi-structured face-to-face interview followed by administration of self-reported questionnaire using the World Health Organization's Quality of Life HIV brief questionnaire (WHOQOL-HIV-BREF).
Results:
Results showed that unemployment, low income, non-disclosure status, single status (separated, divorced or widowed), and having comorbidities were connected with poor HRQoL.
Conclusion:
PLWHA require more than just being provided with antiretroviral therapy to rebuild their lives.
... Older PLWH are 2-3 times more likely to suffer from depression than the general population [3,4]. Older PLWH also report lower levels of physical ability than younger PLWH [5]. HIV decreases bone mineral density and increases osteoporosis, making older PLWH at an increased risk of fall-related injuries [6,7]. ...
Background:
Almost half of people living with HIV (PLWH) in the USA are over 50 years of age; this is expected to increase to 70% by 2020. Yet, few interventions exist for older PLWH that address psychological and physical symptoms combined, both prevalent in this population. There is a need to find innovative and accessible interventions that can help older PLWH to manage their symptoms. Mind-body interventions, like tai chi/qigong (TCQ), improve both physical and psychological health. TCQ is a series of slow, low-impact meditative movements that integrates breathwork, meditation, and stances.
Methods:
The present study is an exploratory clinical trial that will evaluate the acceptability and feasibility of a 12-week, small group TCQ intervention (n = 24), a sham qigong control condition (n = 24), and a standard of care control condition (n = 24) for older people living with HIV/AIDS. It will also explore any preliminary associations between the TCQ intervention and symptom alleviation. Participants will be recruited from community-based health and social services organizations in Miami, FL, and randomized to one of the 3 conditions.
Discussion:
We will assess feasibility and acceptability through questionnaires and adherence to TCQ. We will assess preliminary associations with symptoms such as depression, anxiety, social support, chronic HIV-related fatigue, and clinical outcomes. These will be described through proportions, means, and changes over time through graphing techniques. Outcomes will be assessed at baseline, at post-intervention, and at 3 months follow-up. These preliminary analyses also will provide information necessary to estimate effect size and power needed for a larger clinical trial.
Trial registration:
ClinicalTrials.gov NCT03840525 . Registered on 16 July 2018.
... In this study female patients had lower scores in social relationships and spiritual/religious/personal domains. These results correlate with those obtained by Pereira & Canavarro [15] who also used WHOQOL-HIV-Bref. Other authors in their study [16] state that in this group the lowest scores for QoL could be related to cultural, educational and socioeconomic differences between genders. ...
... Since 1996, optimizing adherence to Antiretroviral Therapy (ART) has brought the chance to transform HIV-an incurable disease-into a chronic health condition [6], which in turn prolongs the life of PLWHA and improves their QOL [6]. In many settings, poor QOL is associated with a lower immune response, non-adherence, poor mental health, and greater disease severity [7][8][9]. Therefore, QOL attracted great attention from regulatory authorities and health providers as an important outcome to evaluate the effectiveness of HIV treatment [10][11][12][13]. People who were effectively treated with HAART, however, have been found to have a lower QOL compared with other long-term chronic illnesses [14]. ...
Quality of life (QOL) has been considered as an important outcome indicator in holistic care for HIV-infected people, especially as HIV/AIDS transforms from a fatal illness to a chronic condition. This study aimed to identify trends and emerging topics among research concerning the QOL of people living with HIV/AIDS (PLWHA). The analyzed data were English papers published from 1996 to 2017, searched and extracted from the Web of Science Core Collection. Collaborations between countries and the correlation between the keywords were visualized by VOSviewer while the abstracts’ content was analyzed using exploratory factor analysis and Jaccard’s’ similarity index. There has been an increase in both the number of publications and citations. The United Nations of America leads in terms of paper volume. The cross-nation collaborations are mainly regional. Despite a rather comprehensive coverage of topics relating to QOL in PLWHA, there has evidently been a lack of studies focusing on socio-cultural factors and their impacts on the QOL of those who are HIV-infected. Further studies should consider investigating the role of socio-cultural factors, especially where long-term treatment is involved. Policy-level decisions are recommended to be made based on the consideration of cultural factors, while collaborations between developed and developing nations, in particular in HIV/AIDS-ridden countries, are strongly recommended.
... Studies suggest that older PLHIV are less happy, less resilient, have poorer attitudes towards ageing and report earlier and more rapid decline in health and independence than their HIV-negative peers. 11 As they age, PLHIV are forced to grapple with issues such as impending retirement from the workforce, disengagement and/or uncertainty about their role in society, finances and long-term housing with their own increasing care needs. Although efforts were made to promote "successful ageing" in Singapore, the prospects of living with HIV-a stigmatised chronic condition-can heighten anxiety and uncertainty over the ageing process. ...
... The quality of life of PLWHA, both men and women, was in the intermediate category. This study contradict previous studies that show differences in the assessment of QoL between genders (21), (22). In terms of marital status, most of the respondents are married. ...
Background:
The quality of life (QoL) construct has also contributed to understanding the comprehension of factors involved in the existence of people infected by the HIV/AIDS. The objective of this study is to assess the quality of life (QoL) of people with HIV/AIDS (PLWHA) in Wonogiri District, Indonesia.
Methods:
A cross-sectional study was conducted from September to November 2017. Convenience sampling method was employed to recruit 39 people living with HIV/AIDS (PLWHA) at Voluntary Counselling and Testing (VCT) of Wonogiri, Indonesia. Research data were collected using a self-administered questionnaire of WHOQOL-HIV BREF. The data were further analysed using a t-test and a Chi-square test, while linear regression was used to evaluate factors that correlate with the PLWHAs' quality of life.
Results:
The results showed that the gross mean score of social relationships domain is 13.59; psychological domain is 13.31; environment domain is 13.28; spiritual/personal beliefs domainis 13.15; physical domain is 13.10; and level of independence domain is 13.77. The symptom of HIV is associated with quality of life (B = 7.611, β = 0.362, t = 2,046, p value = 0.049).
Conclusion:
Healthcare provider should increase providerinitiated testing and counselling (PITC) to contracting group, high risk group, susceptible group, and the community. The PLWHA are recommended to actively participate in peer support groups (PSGs) so that they can improve their quality of life.
... Individuals with HIV disease also report lower QoL than seronegative individuals do (e.g., Hays et al., 2000;Moore et al., 2013). Furthermore, older age is associated with lower health-related QoL among HIV+ adults (Pereira & Canavarro, 2011). Specifically, HIV and aging have been shown to have additive effects on QoL related to physical functioning and general health perceptions, as well as interactive effects on QoL related to emotional functioning (Morgan et al., 2012). ...
Objective:
Retrospective and prospective memory deficits are associated with lower quality of life (QoL); however, there are no validated measures that comprehensively and directly assess the impact of memory problems on QoL. The Survey of Memory-Related Quality of Life (SMRQoL) was developed as a 30-item questionnaire to measure memory-related QoL.
Method:
Both HIV+ (n = 195) and HIV- (n = 146) participants completed the SMRQoL, a neurocognitive research battery, and validated self-report questionnaires of memory, QoL, and mood. Participants were recruited into younger (age ≤ 40 years) and older (age ≥ 50 years) groups per the parent study design.
Results:
The SMRQoL had a unidimensional factor structure and demonstrated measurement invariance across the HIV+ and HIV- participants. Analyses of 111 clinically stable participants (e.g., persons with no incident or remitting central nervous system disorders) who returned for a 14-month follow-up visit indicated that the SMRQoL had adequate test-retest stability. There was a significant interaction of age and HIV status on the SMRQoL, such that older HIV+ participants reported the lowest memory-related QoL. SMRQoL scores were associated with validated measures of mental and physical QoL, self-reported memory and cognitive symptoms, and performance-based memory and executive functions.
Conclusions:
The SMRQoL shows evidence of reliability and validity as a measure of memory-related QoL that can be used to assess the impact of memory problems on everyday life, but future work is needed to demonstrate the measure's incremental value in the context of diagnosis and treatment.
... Older adults were defined as individuals aged 50 years or older according to the current international standard for the elderly in the field of HIV/AIDS research (Pereira & Canavarro, 2011). ...
Coping strategies play a prominent role in maintaining mental health, but little is known about the main coping strategies and potential influential factors among older Chinese adults with HIV/AIDS. Cross-sectional data of 254 older with HIV/AIDS aged 50 ~ 84 years (160 males and 94 females) from Hunan, China were analyzed to evaluate influential factors associated with coping strategies. The scores of all participants in the different sub-scales of confrontation, avoidance and acceptance-resignation were 15.16 ± 4.03, 16.44 ± 2.70, and 11.06 ± 4.00, respectively. For the confrontation coping strategy, higher scores were obtained by those with a higher education level, non-sexually transmitted HIV, and a first diagnosis at less than 50 years old. Avoidance as a coping strategy was significantly associated with a longer period living with the diagnosis. The participants who were females, unemployed, annual income less than 1000 yuan, had lived with HIV for a longer period, and had disclosed their infection status to their family members were more likely to adopt the acceptance-resignation coping strategy in response to HIV/AIDS. These preliminary findings can provide evidence for effective interventions to improve coping capacity and psychological status in this population.
... Employment has also been associated with increased independence for PLWHA (Hergenrather, Rhodes, & Clark, 2006;Paul-Ward, Kielhofner, Braveman, & Levin, 2005;Pereira & Canavarro, 2011). Hergenrather, Rhodes, and Clark (2006) utilized the Photovoice method to identify the motivations for PLWHA to seek employment. ...
The development of highly active antiretroviral therapy (HAART) has shifted human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) from an acute to a chronic condition. Due to reduced fatality, approximately 1.1 million people living with HIV/AIDS (PLWHA) are faced with increased longevity in conjunction with functional consequences associated with chronic disability. Employment has been associated with increased treatment adherence, quality of life (QoL), and mental and physical health for people living with HIV/AIDS. The purpose of this study was to determine the relationship between employment status and QoL for PLWHA. Participants included 115 patients receiving services from two Ryan White HIV/AIDS Program (RWHAP) clinics in a rural Mid Atlantic Appalachian region of the U.S. Findings revealed statistically significant differences in employment status on six domains of the World Health Organization’s Quality of Life scale for PLWHA (WHOQOL-HIV-Bref), except for spirituality/religion/personal beliefs. Implications for practice and research are discussed.
... In this study, being female was associated with low QoL in the psychological and spirituality domains. Similar results have been reported previously 8,9,16 . A study that assessed QoL of women with HIV/AIDS revealed that those with income of more than one minimum wage and holding a job had higher QoL scores in the psychological domain. ...
Abstract INTRODUCTION: Quality of life (QoL) is important for people living with HIV/AIDS, particularly as the disease progresses. This study evaluated the QoL of people living with HIV/AIDS (PLWHA), as well as its predictors, in one of the most impoverished regions of Brazil. METHODS: This cross-sectional study was conducted with patients older than 18 years with HIV/AIDS from two specialized HIV/AIDS care centers in the city of Montes Claros between 2013 and 2014. Sample size was calculated considering the estimates of mean scores for various dimensions of the European Portuguese version of the World Health’s Organization Quality of Life Instrument in HIV Infection (WHOQOL-HIV Bref). The following parameters were adopted: CI of 95%, estimated mean scores for QoL equal to 15, estimated variance for QoL scores equal to 16, and 5% relative margin of error. An increase of 20% was established to compensate for possible non-responses or losses, and correcting any design effect, adopting a deff equal to 2.0. Calculations revealed the need to interview at least 221 patients. Therefore, 226 patients living with HIV/AIDS were randomly selected. RESULTS: A total of 226 patients with mean age 43.7 years were evaluated: 51.8% men, 51.8% unemployed, 51.8% with low schooling level, 89.8% used antiretrovirals, and 43.3% experienced depression. Despite this, data indicated that 65% self-assessed their QoL as good and very good. Low QoL was associated with sociodemographic variables and some clinical variables. CONCLUSIONS: Depression was the main predictor of low QoL in all domains evaluated.
... Employment has also been associated with increased independence for PLWHA (Hergenrather, Rhodes, & Clark, 2006;Paul-Ward, Kielhofner, Braveman, & Levin, 2005;Pereira & Canavarro, 2011). Hergenrather, Rhodes, and Clark (2006) utilized the Photovoice method to identify the motivations for PLWHA to seek employment. ...
The development of highly active antiretroviral therapy (HAART) has shifted human immunodeficiency
virus (HIV) and acquired immune deficiency syndrome (AIDS) from an acute to a chronic condition. Due to
reduced fatality, approximately 1.1 million people living with HIV/AIDS (PLWHA) are faced with increased
longevity in conjunction with functional consequences associated with chronic disability. Employment has
been associated with increased treatment adherence, quality of life (QoL), and mental and physical health
for people living with HIV/AIDS. The purpose of this study was to determine the relationship between
employment status and QoL for PLWHA. Participants included 115 patients receiving services from two
Ryan White HIV/AIDS Program (RWHAP) clinics in a rural Mid Atlantic Appalachian region of the U.S.
Findings revealed statistically significant differences in employment status on six domains of the World
Health Organization’s Quality of Life scale for PLWHA (WHOQOL-HIV-Bref), except for spirituality/
religion/personal beliefs. Implications for practice and research are discussed.
Keywords: HIV/AIDS, PLWHA, employment, quality of life
... This inverse association between age and physical health observed in the present study is in line with the findings of a previous review [40]. In a study with 1191 HIV-positive patients, participants aged over 45 years reported lower scores on the physical domain of the HRQOL than did those aged under 34 years [52]. Relatedly, a previous study found that nearly half of older people with HIV had at least one major medical comorbidity, and a greater burden of co-morbidity was associated with a lower physical HRQOL [53]. ...
Background:
Precise assessment of health-related quality of life (HRQOL) with a reliable and valid measure is a prerequisite to the enhancement of HRQOL. This study examined the psychometric properties of the Korean version of the Medical Outcomes Study HIV Health Survey (K-MOS-HIV).
Methods:
The reliability and validity of the K-MOS-HIV were examined in a multicenter survey involving 201 outpatients with human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) from four teaching hospitals throughout Korea.
Results:
Ceiling effects were observed in six subscales scores, particularly, for the role functioning (71.1%), social functioning (63.2%), and pain (48.8%) scores. The Cronbach's α for the physical health summary and mental health summary were 0.90 and 0.94, respectively, and it ranged from 0.78 to 0.95 for the subscales. The results of the exploratory structural equation modeling supported the two-factor structure of the K-MOS-HIV (physical health summary and mental health summary). An examination of the mean square statistics values from the Rasch analysis showed that the information-weighted fit and outlier-sensitive fit statistics were within the acceptable ranges of 0.6-1.4 except for two items in the mental health summary. The convergent validity of the K-MOS-HIV was supported by its significant positive correlations with the World Health Organization Quality of Life-HIV-BREF subscale scores. Its known-group validity was proven with its ability to detect significant differences in several K-MOS-HIV subscale scores among participants with different sociodemographic and clinical characteristics.
Conclusions:
The K-MOS-HIV health survey appears to be a reliable and valid measure of HRQOL.
... Contrary to our findings, the studies by Gaspar et al and Pereira and Canavarro demonstrated that 41.4% and 46.5% of women had primary and secondary educational levels, respectively. 11,23 Our findings revealed that a statistically significant relationship was found between husband's educational level and the women's QOL. In other words, the husband's educational level had a positive impact on women's QOL (P ¼ .009). ...
AIDS affects physical, mental, social, and psychological health status. One of the goals of Health for All in the 21st century is to improve the quality of life. This study is a randomized clinical trial conducted on 120 HIV-positive women. Women were administered assessment questionnaires to be completed during the structured interview. After sample collection, participants were divided randomly into 3 groups by using the table of random numbers, then, respectively, received educational intervention, empowerment program, and routine procedures offered by the center and were followed by refilling the questionnaires 12 weeks after intervention. Depending on the type of data, chi-square, analysis of variance, and paired t test were used, and SPSS version 16 was used for data analysis. The finding showed that knowledge increased after intervention in educational (P = .02) and empowerment groups (P = .006); also empowerment group indicated significant difference in psychological (P = .006) and spiritual (P = .001) domains and their total quality of life (P = .004). According to this study, exposing HIV-positive women to empowerment education is effective in improving their quality of life.
... Therefore social support is an influential variable in quality of life of AIDS patients, and the first hypothesis is accepted. Similar findings are reported by Pereira and Canavarro [23], they found significant gender differences in quality of life among HIV infected patients, Shin [15], also affirmed that positive function of social support influences the health related quality of life among HIV/ AIDS patients. Simultaneously Friedland et al. [17] reported that social support positively affects the quality of life among people living with AIDS (PLWHA). ...
Since 1981, AIDS remains one of the alarming issues in public health. It kills more than 39 million people globally. In this silent killer disease, patients not only suffer physiologically and economically but psychologically too. Their psychological well-being, mental health and quality of life also affected. The cardinal objective behind the present research was to investigate the effect of social support on quality of life of AIDS patients. Further, the study strived to find the level of social support and quality of life among male and female; married and unmarried AIDS patients. This study consisted sample of 60 AIDS patients with equal number of male and female patients selected through purposive sampling technique. Quality of Life was measured by Quality of Life Scale and for assessment of Social Support among patients Enriched Social Support Inventory was applied. For statistical analysis Mean, t-Test, Pearson Correlation and One Way ANOVA was applied by using SPSS 16.0 version. The findings show that male and married AIDS patients have a better level of quality of life than female and unmarried AIDS patients; they also receive more social support than female and unmarried patients. The results also revealed that two demographical variables gender and marital status are negatively significant correlated with Social Support and Quality of Life. Concurrently Social Support was found positively significant correlated with quality of life. On the basis of the findings in the present study we may conclude that gender, marital status as well as Social support are influential variables in quality of life. All these three variables have their impact on quality of life.
... A detailed description of the methodology used in this study has been reported elsewhere. 10 In brief, the general inclusion criteria were age (≥18 years), diagnosis of HIV, and sufficient knowledge of Portuguese to complete the assessment protocol. ...
The purpose of this study was to examine the reliability and validity of the EUROHIS-QOL 8-index in a sample of 1197 HIV-infected patients, recruited in the departments of infectious diseases of 10 Portuguese hospitals. The EUROHIS-QOL-8 index showed good internal consistency (Cronbach's alpha = 0.85) adequate construct, convergent and known-groups validity. Confirmatory factor analysis supported its unidimensional structure. The properties of the EUROHIS-QOL 8-index support its use in the Portuguese HIV population, particularly in large studies requiring the assessment of multiple health indicators and in studies needing more practical, shorter, and easier to apply instruments for assessing quality of life.
... Several demographic and family characteristics were found to be related to the mental health status of the PLH and their family members. Women reported more depressive symptoms than men, similar to the findings of other studies (Passos & Souza, 2015;Pereira & Canavarro, 2011). In traditional Chinese families, women are typically the primary caregivers (Stein et al., 2000). ...
Objective:
HIV has a profound impact on infected individuals and their families. This study evaluated the efficacy of an intervention aimed at improving the mental health of people living with HIV (PLH) and their family members.
Method:
A randomized controlled trial of 475 PLH and 522 family members was conducted in Anhui, China. The intervention comprised activities at individual, family, and community levels. The study outcomes, which included depressive symptoms and coping with illness for the PLH and depressive symptoms and caregiver burden for the family members, were assessed at baseline and at 6-, 12-, 18-, and 24-month follow-up. We used a mixed-effects regression model with village- and participant-level random effects to assess the intervention effect on the improvement of outcome measures.
Results:
Relative to the control condition, the PLH and family members of the intervention group reported a significant reduction in depressive symptoms. The largest difference in depressive symptoms was observed at 6 months for the PLH and at 12 months for family members. Decreases in perceived caregiver burden over time were observed for family members in both conditions; however, the group difference did not reach statistical significance. Significant intervention effect on the coping with illness was reported by the PLH.
Conclusions:
The study highlights the importance of empowering families affected by HIV to confront the challenges together rather than individually. It may be optimal for future programs to include both PLH and their family members to maximize intervention effects through strengthening interactions and support within a family. (PsycINFO Database Record
... In terms of external demographic factors, the link between QoL and, for example, age (García, Pinilla, & Peiró, 2006), level of education (Skevington, 2010), and gender (Pereira & Canavarro, 2011) has been studied. At a social level, the influence of culture (García, 2005), socioeconomic status (Ali, Dabiran, Safdari, & Djafarian, 2010), and social support (Kamil et al., 2006) have been studied. ...
Using a non-experimental, transverse, co-relational design, we assess the relationship between optimism and quality of life (QoL) in adults aged between 18 and 65 years. Two questionnaires were administered: WHOQOLBREF, which assessed QoL, and an instrument that assessed trait–state optimism. A total of 1190 subjects from various public and private high schools, institutions and commercial centers in the city of Antofagasta, Chile participated. The mean sample age was 40.0 years and 50.0% of respondents were male. There is a relationship between QoL and state optimism, with males demonstrating a higher QoL. Differences in optimism were observed only in age groups in which younger persons scored less than older persons. The results obtained indicate that there is a partial relationship between QoL and optimism, with state optimism having a significant effect on QoL.
... Participants of this study were invited to participate while attending a consultation with their infectious disease specialist. The recruitment procedures have been described with more detail elsewhere (Pereira & Canavarro, 2011). A total of 1251 patients attending the main departments of infectious diseases of 10 Portuguese hospitals were consecutively recruited by convenience. ...
The aims of this study were to examine the prevalence and correlates of psychological distress among older women living with HIV in comparison to their male counterparts and younger women and to identify the sociodemographic and disease-related factors associated with psychological distress. The sample consisted of 508 HIV-infected patients (65 older women, 323 women aged below 50 years, and 120 older men) recruited from 10 Portuguese hospitals. Data regarding psychological distress were collected using the Brief Symptom Inventory (BSI). Seven older women (10.8%), eight older men (6.7%), and 61 younger women (18.9%) reported a T-score ≥ 63 for global severity index (GSI), indicative of a need for further psychological evaluation. Overall, younger women reported significantly higher psychological distress than older men. The odds of having clinically significant psychological distress score were significantly lower for older women reporting sexual transmission, while for younger women, having other co-infections was a significant correlate of higher psychological distress. Younger women were 2.67 (95% CI: 1.22–5.84) times more likely to report psychological distress than were older men. The odds were not significantly different from older women. This study shows that older women do not differ substantially from younger women and older men in terms of psychological distress. The results reinforce, however, that mental health interventions should be tailored to reflect individuals’ circumstances as well as developmental contexts. Moreover, they draw attention to the importance of examining resilience characteristics in older adults to understand the mechanisms behind ‘successful ageing’ while living with HIV.
... A strong correlation between female gender and depressive symptoms has been documented in the literature, among populations with and without HIV/AIDS (Kockler & Heun, 2002;C. H. Lai, 2011;Lichtenstein et al., 2002;Pereira & Canavarro, 2011;Romans, Tyas, Cohen, & Silverstone, 2007). Previous literature has also consistently indicated that Chinese women bear greater mental health burdens than men (Hou, Cerulli, Wittink, Caine, & Qiu, 2015;Phillips et al., 2009), primarily due to women's lower education, unemployment, financial dependence, and limited available social support (Hou et al., 2015;Lu et al., 2008). ...
HIV seropositive individuals and their heterosexual partners/spouses, either seropositive or seronegative, are facing several mental health challenges. The objective of this study was to examine gender differences in depressive symptoms among HIV-positive concordant and HIV-discordant couples. We identified heterosexual couples from participants of a randomized controlled trial conducted in Anhui province, China. A total of 265 couples, comprising 129 HIVþ male/HIV� female couples, 98 HIV� male/HIVþ female couples, and 38 HIV-positive concordant couples, were included in the analyses. We collected data using the computer-assisted personal interview method. We used a linear mixed-effects regression model to assess whether gender differences in depressive symptoms varied across couple types. HIV-positive women reported a significantly higher level of depressive symptoms than their partners/spouses. HIV-positive women with HIV-positive partners had higher
depressive symptoms than those with HIV-negative partners, whereas HIV-positive men reported similar levels of depressive symptoms regardless of their partners’ serostatus. Among the concordant couples, those with the highest annual family income showed the greatest gender differences in depressive symptoms. We suggest that family interventions should be gender- and couple-type specific and that mental health counseling is warranted not only for HIV-positive women but also for HIV-negative women in an HIV-affected relationship.
... Of the six studies looking at gender and subjective health measures, only one -using a non-random sampling procedure -showed no association [19]. All others showed a strong association favouring men [28,32,47,50,51]. Perelman (2012), for example, used a community sample of over 30,000 randomly selected adults (from the National Health Survey) and after adjusting for other SES indicators such as income, marital status, occupation, employment, among others, showed that women still had between 1.4 and 2.3 higher odds of reporting bad SRH [32]. ...
Introduction
Health inequalities are recognised as a public health issue worldwide, but only a few countries have developed national strategies to monitor and reduce them. Despite its considerable health inequalities, Portugal seems to lack a systematic strategy to tackle them, possibly due to the absence of organised evidence on the issue. We performed a systematic review that aimed to describe the available evidence on social inequalities in health in Portugal, in order to contribute towards a comprehensive and focused strategy to tackle them.
Methods
We followed the PRISMA guidelines and searched Scopus, Web of Science and PubMed for studies that looked at the association between a measure of socioeconomic status and a health outcome in the Portuguese resident population since the year 2000. We excluded health behaviours and healthcare use from our search. We performed a qualitative description of the results.
Results
Seventy-one publications were selected, all reporting observational analyses, most of them using cross-sectional data. These publications showed strong evidence for health inequalities related to education and gender, chiefly for obesity, self-rated health and mental health.
Conclusions
Analysis of the eligible publications showed that current research does not seem to have consistently covered the link between health and key Portuguese social problems. A strategy focusing on the monitoring of most prevalent diseases, most determining socioeconomic factors and vulnerable populations would be crucial to guide academic research in a country in which health inequalities are so ubiquitous and deeply rooted.
HIV/AIDS is the most pandemic and dreaded sexual health related disease among the other chronic diseases affecting the human lives. The prevalence of the HIV/AIDS not only encounters the quality of life among people living with HIV/AIDS (PLWHIV/AIDS) but also affects their daily routine. The objective of the study was to find the quality of life among the PLWHIV/AIDS. A comparative study was done on 100 HIV/AIDS infected people (50 from Jaipur and 50 from Bharatpur) using WHOQOL BREF scale. The result shows a significant difference in quality of life among people living with HIV/AIDS in metropolitan city and small city. Males are showing a higher level of mean value in all the respective domains of quality of life compared to females of Jaipur and Bharatpur.
Entering HIV care is a vulnerable time for newly diagnosed individuals often exacerbating psychosocial difficulties, which may contribute to poor health-related quality of life (HRQOL) ultimately influencing health behaviors including ART adherence, the driver of viral load suppression. Understanding HRQOL in people newly entering HIV care is critical and has the potential to guide practice and research. This exploratory cross-sectional study examined demographic, clinical, and psychosocial factors associated with limitations in four specific domains of HRQOL among persons initially entering outpatient HIV care at four sites in the United States (n = 335). In the unadjusted analysis, female gender was significantly associated with sub-optimal HRQOL with women having increased odds of reporting HRQOL challenges with pain, mood, mobility, and usual activity when compared to men. The adjusted models demonstrated attenuation of parameter estimates and loss of statistical significance for the associations with impaired HRQOL observed among women in unadjusted analyses, suggesting psychosocial factors related to HRQOL are complex and interrelated. Findings are consistent with a robust literature documenting gender-related health disparities. Programs aimed at improving HRQOL for persons initially entering HIV care are warranted generally, and specifically for women, and must address modifiable psychosocial factors via mechanisms including coping and social support.
Studies exploring gender differences in health-related quality of life (HRQOL) of people living with
HIV/AIDS (PLWHA) are scarce and contradictory. This study evaluated gender differences in HRQOL
of 744 PLWHA with median (IQR) age 44 (37–48) years and HIV infection diagnosed 12 (5–20) years
earlier. Results showed important differences between genders (p < .05). Better male physical health
was related to being employed, not having economic worries, not receiving psychological support,
not having injected drugs in past, low negative mood HIV-related, low HIV illness representation
and internalized stigma, and high body image satisfaction and health behavior. For women,
variables were fewer years since HIV diagnosis and low enacted stigma-personal experience of
rejection. Mentally, variables in men were being employed, not having injected drugs, having a
stable partner, high health behavior, use of problem-solving coping, personal autonomy and
personal meaning. In women, better mental health was related to high CD4 cells, self-esteem
and body image satisfaction, and negative mood HIV-related. Men and women coincided in
absence of past opportunistic infections being related to better physical and mental health, and
absence of side effects for physical health and low HIV-related stress and HIV illness
representation for mental health. Our results highlight the need for detailed study of gender
differences that identify the bio-psycho-socio inequalities that affect HRQOL.
Objective:
to analyze the quality of life of people living with HIV/AIDS and its relationship with sociodemographic variables, health satisfaction and time since diagnosis.
Method:
quantitative, cross-sectional study with a sample of 100 HIV positive people monitored in a specialized service in southeastern Brazil. Sociodemographic and health forms were applied, followed by the WHOQOL-HIV BREF, a short form instrument validated to evaluate the quality of life. Descriptive and inferential statistical analysis was performed.
Results:
the perception of quality of life was intermediate in all quality of life domains. A relationship was identified between greater satisfaction with health and better quality of life, as well as statistically significant differences among the dimensions of quality of life according to gender, employment status, family income, personal income, religious beliefs and time since diagnosis.
Conclusions:
the time since the diagnosis of HIV infection enables reconfigurations in the perception of quality of life, while spirituality and social relationships can assist in coping with living with this disease.
Improved life expectancy of people on antiretroviral therapy has increased focus on quality of life issues. The objectives of this study were to assess the quality of life in people on antiretroviral therapy; determine the sociodemographic and clinical predictors of quality of life in people on antiretroviral therapy and to evaluate the reliability of the World Health Organization Quality of Life BREF (WHOQOL BREF) instrument. The study was conducted using a descriptive correlational survey at Masvingo Provincial Hospital Opportunistic infections (OI) Clinic.A randomly selected sample of 300 participants, on antiretroviral drugs was interviewed through standardized interviewing. The interview schedule had 36 items, inclusive of the 26-item WHOQOL BREF.Transformed qualities of life were: Domain 1 (Mean = 67.2, SD = 16.08) followed by Domain 2 (Mean = 65.56; SD = 16.11), Domain3 (Mean = 63.83; SD = 19.30) and, lastly, Domain 4 (Mean = 55.84; SD = 16.71). The mean transformed overall quality of life score was 63.11 (SD = 14.06). Statistically significant positive correlates for quality of life included being male, a period of more than 3 years on ART, monthly income above US$250 and Islam religion. Statistically significant negative correlates of quality of life included being an urban dweller, being single, unemployed, a pensioner or a traditionalist. The coefficients of determination for the predictors was r 2 = 0.19, r 2 = 0.22, r 2 = 0.23 and r 2 = 0.31 for domain 1, 2, 3 and 4 respectively. There was no significant linear relationship between quality of life and respondends'CD4 count. The Cronbach's alpha for the WHOQOL BREF instrument was 0.92. More interventions need to be done for urban dwellers, single individuals, pensioners, unemployed people and traditionalists on ART to improve their quality of life. Quality of life should not be extrapolated from the patient's CD4 count dynamics alone, but should rather be determined separately. The WHOQOL BREF is reliable for monitoring quality of life of individuals on ART.
While substantial research has taken place regarding Psychological Well-Being (PWB) and Quality Of Life (QOL), very few studies have taken place to study the effect of Demographic Variables such as gender, domicile and number of siblings on PWB and QOL. The following study was conducted on both Undergraduate and Postgraduate students (n=273) of Mysore by administering Ryff's Psychological Well-Being Scale (middle version consisting of 54 items) and WHO-Quality of Life Scale BREF. The obtained data was analysed through One-Way ANOVA. It was found that children with 1 or 2 siblings had highest PWB and QOL. Urban students had higher Quality Of Life than rural students. Gender had no effect either on PWB or QOL. Research implications and significance for Mental Health Professionals throughout the globe conclude the article.
Introduction: Quality of Life of people living with HIV/AIDS in Medellin has not been evaluated with specific instruments. Objective: 7b describe the impact of HIV/AIDS in the dimensions of the WHOQOL-HIV BREF in people living with HIV/AIDS in Medellin, Colombia, 2010-2011, and its association with determinants factors. Methods: Cross sectional study in adults with HIV/AIDS in Medellin. We used primary source of information that included a survey with demographic, socioeconomic and clinical aspects, SMAQ and WHOQOL-HIV BREF. The analysis was based on frequency and summary measures, parametric and nonparametric tests, and linear regression. Results: In all dimensions of quality of life the score was equal to or greater than 60, the lowest score was observed in the physical health and greater independence. The main determinants of quality of life were economic satisfaction, family relationships, education, comorbidities and social stratum. Conclusion: Due to the increasing prevalence of HIV/AIDS, the effectiveness of antiretroviral therapy, its chronic nature, the possibility of treatment and survival, quality of life is a key factor for those living with the infection.
This study investigated 3 broad classes of individual-differences variables (job-search motives, competencies, and constraints) as predictors of job-search intensity among 292 unemployed job seekers. Also assessed was the relationship between job-search intensity and reemployment success in a longitudinal context. Results show significant relationships between the predictors employment commitment, financial hardship, job-search self-efficacy, and motivation control and the outcome job-search intensity. Support was not found for a relationship between perceived job-search constraints and job-search intensity. Motivation control was highlighted as the only lagged predictor of job-search intensity over time for those who were continuously unemployed. Job-search intensity predicted Time 2 reemployment status for the sample as a whole, but not reemployment quality for those who found jobs over the study's duration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The study aims to assess the health-related quality of life and HIV symptoms of a sample of people living with HIV (PLHIV) in South Africa. The sample included 607 PLHIV from all districts of the Eastern Cape Province, recruited either through a health facility, from the community through key informants, or through support groups. At the time of the study, 66% of the respondents reported having been given an AIDS diagnosis (advanced stage of HIV disease), 48% were on antiretroviral therapy (ART), and 35% were receiving a disability grant. The findings indicate a low degree of overall quality of life, with a mean score of 13.4 on the WHOQOL-HIV measure. Among the WHOQOL-HIV BREF subscales, logistic regression identified spirituality, environment, psychological health, and level of independence as predictors for overall quality of life. Among medical variables and HIV symptoms, CD4 cell count and having fewer HIV symptoms but not an AIDS diagnosis were identified as predictors for overall quality of life; among socio-economic variables, having sufficient food and a higher educational level were identified as predictors. The results highlight the need for better access to psychosocial support and medical services for PLHIV in South Africa, as well as the need to consider a patient's general health perceptions during the course of ART.
Quality of life is an important component in the evaluation of the well-being of HIV-infected patients. In the present study,
an attempt has been made to compare HIV-infected patients across the three stages namely, asymptomatic, symptomatic, and AIDS-related
conditions. This is a cross-sectional study. For this study, a total number of 90 subjects, 30 each in asymptomatic, symptomatic,
and AIDS-related conditions, were taken. The study population consisted of HIV positive individual already enrolled in Voluntary
Counseling and Testing Center, Institute of Medical Science, Banaras Hindu University, Varanasi, India. The WHOQOL-HIV BREF
was used to assess quality of life across the group of patients. One-way analysis of variance was performed to find out significant
difference between the clinical categories. On average AIDS patients experienced significantly poorer quality of life in all
the six domains, namely physical (M=7.87, SD=1.83), psychological (M=8.50, SD=1.54), level of independence (M=8.57, SD=1.59), social relation (M=9.17, SD=2.59), environment (M=8.78, SD=1.50), and spirituality/religion/personal belief (M=6.93, SD=1.26) to symptomatic and asymptomatic HIV-infected people (p=.000). Result suggested that there is an inverse relationship between quality of life and different stages of HIV infection.
This paper examined gender differences in Quality of Life (QOL) among people living with HIV/AIDS in South India using the locally validated version of the WHO Quality of Life Instrument for HIV (WHOQOL-HIV 120). Participants (N = 109) were men and women with HIV1 Clade C infection participating in a cohort study. There was no gender difference in CD4 counts or use of antiretroviral therapy. Of the 29 facets of QOL, men reported significantly higher QOL in the following facets-positive feeling, sexual activity, financial resources and transport, while women reported significantly higher QOL on the forgiveness and blame facet. Of the six domains of QOL, men reported better quality of life in the environmental domain while women had higher scores on the spirituality/religion and personal beliefs domain. Understanding these gender differences may provide potentially useful information for tailoring interventions to enhance QOL among people infected with HIV/AIDS.
Elevated psychological distress during HIV infection has been consistently correlated with negative HIV-related health outcomes in studies conducted in various regions of the world. This study was conducted to compare the nature and range of psychological distress among HIV-infected individuals who had sought mental health care as part of their HIV care in Kenya and the United States. The Brief Symptom Inventory (BSI) was completed by 234 individuals with HIV in Atlanta, Georgia, USA, and 284 in Eldoret, Kenya. The US-based sample expressed markedly higher levels of psychological distress symptoms on the anxiety, depression, interpersonal sensitivity, obsessive-compulsive, and psychoticism dimensions, as well as the overall global severity index. Substantial proportions of both the US and Kenya cohorts expressed higher levels of somatization and paranoid ideation that suggested further psychological evaluation. This study revealed psychological distress expression varied drastically among individuals who self-enrolled into HIV-related mental health care within two different care infrastructures.
Current research indicates that emotional support is strongly associated with physical and psychological adjustment in persons living with HIV/AIDS. While gender- differences in health and health behaviors of HIV positive patients are well studied, less is known about how men and women living with HIV/AIDS may differentially perceive and integrate support into their lives, and how it subsequently affects their psychological well-being. This cross-sectional study examines how emotional support received from partners and family/friends and gender explains psychological well-being (i.e., stress, depression, anxiety) in a sample of 409 partnered European HIV positive individuals. We hypothesized that gender would modify the associations between support and psychological well-being such that men would benefit more from partner support whereas women would benefit more from family/friend support. Results revealed that regardless of the source of support, men's well-being was more positively influenced by support than was women's well-being. Women's difficulties in receiving emotional support may have deleterious effects on their psychological well-being.
At the beginning of the 1990s, the World Health Organization (WHO) developed a project in order to create a cross-cultural instrument of quality of life assessment: the World Health Organization Quality of Life (WHOQOL).
This paper describes the development of the European Portuguese version of the WHOQOL-100, according to the methodology recommended by the WHO.
Special attention is given to the qualitative pilot study, which led to the development of the Portuguese Facet [Political P], and to the empirical pilot study and the psychometric studies, based on the application of the Portuguese version of the instrument to a sample of 315 subjects from the general population and 289 patients. The assessment protocol also included the Beck Depression Inventory and the Brief Symptom Inventory.
The Portuguese version of WHOQOL-100 showed acceptable internal consistency (alpha range 0.84-0.94) and test-retest reliability in all domains (r range 0.67-0.86). Discriminant validity was significant for all domains, except in Spirituality. Convergent validity with the Beck Depression Inventory and the Brief Symptom Inventory was satisfactory for most domains.
The WHOQOL showed good psychometric characteristics, suggesting that the Portuguese version of WHOQOL is valid and reliable in the assessment of quality of life in Portugal.
The assessment of quality of life is central to understanding how people's lives are affected by HIV infection. Estonia--the smallest of three Baltic countries--has experienced massive outbreak of HIV infection. Yet, little is known about the quality of life of HIV infected people in Estonia. The purposes of the present study were to adapt the World Health Organization's Quality of life HIV instrument (WHOQoL-HIV) into Estonian setting and to assess the quality of life in a sample of HIV-infected persons in Estonia.
To measure health-related quality of life among adult patients with human immunodeficiency virus (HIV) disease; to compare the health-related quality of life of adults with HIV with that of the general population and with patients with other chronic conditions; and to determine the associations of demographic variables and disease severity with health-related quality of life.
We studied 2,864 HIV-infected adults participating in the HIV Cost and Services Utilization Study, a probability sample of adults with HIV receiving health care in the contiguous United States (excluding military hospitals, prisons, or emergency rooms). A battery of 28 items covering eight domains of health (physical functioning, emotional well-being, role functioning, pain, general health perceptions, social functioning, energy, disability days) was administered. The eight domains were combined into physical and mental health summary scores. SF-36 physical functioning and emotional well-being scales were compared with the US general population and patients with other chronic diseases on a 0 to 100 scale.
Physical functioning was about the same for adults with asymptomatic HIV disease as for the US population [mean (+/- SD) of 92+/-16 versus 90+/-17) but was much worse for those with symptomatic HIV disease (76+/-28) or who met criteria for the acquired immunodeficiency syndrome (AIDS; 58+/-31). Patients with AIDS had worse physical functioning than those with other chronic diseases (epilepsy, gastroesophageal reflux disease, clinically localized prostate cancer, clinical depression, diabetes) for which comparable data were available. Emotional well-being was comparable among patients with various stages of HIV disease (asymptomatic, 62+/-9; symptomatic, 59+/-11; AIDS, 59+/-11), but was significantly worse than the general population and patients with other chronic diseases except depression. In multivariate analyses, HIV-related symptoms were strongly associated with physical and mental health, whereas race, sex, health insurance status, disease stage, and CD4 count were at most weakly associated with physical and mental health.
There is substantial morbidity associated with HIV disease in adults. The variability in health-related quality of life according to disease progression is relevant for health policy and allocation of resources, and merits the attention of clinicians who treat patients with HIV disease.
The purpose of this study was to describe the relationship between viral load and health-related quality of life (HRQOL) in a cohort of persons with human immunodeficiency virus (HIV) infection.
We evaluated HRQOL measurements in a clinical cohort of HIV-positive patients recruited from a university-associated HIV primary care clinic. HRQOL instruments included the medical outcomes survey-short form-36(MOS-SF-36) from which mental and physical component summary scores (MCS and PCS) and subscale scores were calculated.
Significant negative associations were found between viral load and SF-36 PCS, physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), role-emotional (RE), and vitality (VT). Similar negative associations were found between CD4 cell count and SF-36 summary and subscale scores, with the notable exception of bodily pain. Multivariate analyses controlling for the effects of CD4 cell count and other clinical variables indicated viral load as an independent predictor of SF-36 PCS, RP, BP and VT scores.
The relationship between viral load, a measure of HIV disease activity, and several dimensions of the SF-36, a patient-focused measure of HRQOL, appears to be strong and independent of CD4 cell count. These findings suggest that having a lower viral load positively impacts the quality of life of HIV-positive patients.
Apathy refers to decreased self-initiation and goal-directed behavior. Apathy is a relatively common neuropsychiatric symptom associated with HIV, yet the impact of apathy on health-related quality of life (QOL) has not been investigated. We examined the relationship between apathy, depression, and QOL among individuals infected with HIV. Apathy was quantified using the Marin Apathy scale and QOL was measured with the Medical Outcomes Study Short-Form 36 (SF-36). Results of the study revealed that both apathy and depression were more common among patients with HIV than healthy control subjects. Twenty-six percent of the patients with HIV reported clinically significant apathy while 80% of the patients reported clinically significant depression. Apathy did not relate to ratings of overall QOL, but it was modestly associated with ratings of mental health and role disruption secondary to mental health. By contrast, ratings of depression were strongly related to overall QOL and most indices of SF-36. Regression equations revealed that depression and apathy independently contributed to mental health and role disruption secondary to mental health. Importantly, ratings of depression accounted for the majority of variance for ratings of QOL. The findings indicate that while apathy is more common among individuals with HIV compared to healthy control subjects, the impact of apathy on QOL is less significant than depression. Clinicians should continue to focus on depression as an important neuropsychiatric symptom associated with HIV.
To examine demographic and behavioral associations with self-reported health-related quality of life (HRQOL) among persons with HIV infection or AIDS.
Analysis of interviews with persons > or = 18 years of age reported through routine disease surveillance with HIV infection or AIDS to nine state and local health departments from January 1995 through December 1996. Scales were constructed from validated measures of HRQOL, and mean scores were calculated (lower scores signified poorer HRQOL). Measures of HRQOL included Overall Health, Pain, Physical Functioning, Role Functioning, Social Functioning, Mental Health, Energy/Fatigue, and Cognitive Functioning. Differences in HRQOL were examined by various demographic and behavioral factors, including taking antiretroviral medication.
HRQOL data were available for 3778 persons. Factors associated with lower HRQOL scores included older age, female sex, black or Hispanic race/ethnicity, injection drug use, lower education and income, no private health insurance, and lower CD4 count. In multivariate analysis, lower CD4 count was the factor most consistently associated with lower HRQOL. Taking antiretroviral medication was not associated with differences in HRQOL regardless of CD4 count.
Perception of HRQOL varied in a population with HIV infection or AIDS. On most HRQOL measures, lower CD4 count was associated with lower HRQOL. Measurement of HRQOL can assist in understanding the long-term effects of disease and treatment on persons with HIV.
This paper reports on an international study in 18 countries (n=5087) to observe how spirituality, religion and personal beliefs (SRPB) relate to quality of life (QoL). SRPB is assessed using the World Health Organization's QoL Instrument (the WHOQOL), where eight additional facets were included to more fully address these issues as they pertain to QoL, along with physical, social, psychological and environmental domains. The facets address issues such as inner peace, faith, hope and optimism, and spiritual connection. The results showed that SRPB was highly correlated with all of the WHOQOL domains (p<0.01), although the strongest correlations were found with psychological and social domains and overall QoL. When all of the domain scores were entered into a stepwise hierarchal regression analysis, all of the domains contributed to overall quality of life (N=3636), explaining 65% of the variance. When this was repeated for those people who reported poor health (N=588), it was found that only four domains explain 52% of the variance. The first was the level of independence, followed by environment, SRPB and physical. Gender comparisons showed that despite showing lower scores for facets in the psychological domain, such as negative feelings and poorer cognitions, women still reported greater feelings of spiritual connection and faith than men. Those with less education reported greater faith but were less hopeful. It is suggested that SRPB should be more routinely addressed in assessment of QoL, as it can make a substantial difference in QoL particularly for those who report very poor health or are at the end of their life.
One in 10 persons with AIDS is 50 years of age or older. Yet nurses often fail to identify elders with HIV. Here's how to spot these patients and meet their special care needs.
The objectives of this study were to provide a national profile of socioeconomic circumstances of the middle-aged and older population living with HIV and to evaluate variations in social support and quality of life (QOL) across age and socioeconomic subgroups, controlling for indicators of disease progression. The design used was a cross-sectional analysis of nationally representative interview data on HIV-infected individuals collected in the HIV Cost and Services Utilization Study. Multiple measures of social support and QOL were used. Bivariate comparisons of outcomes across categories of age and exposure category were performed; multivariate analyses to isolate the effect of older age on outcomes within exposure categories were performed, controlling for socioeconomic and clinical co-variates. Study results indicate that older gay men with HIV/AIDS are a predominantly white population and more likely to have health insurance than their younger counterparts; 38% were employed and 48% reported incomes of more than $25,000. Older injection drug users (IDUs) with HIV/AIDS are a predominantly black population with a particularly high concentration of disadvantages; only 11% were employed and 74% reported incomes of less than $10,000. Older IDUs reported especially low levels of physical functioning and emotional support in comparison with their younger counterparts, whereas older gay men did not significantly differ from younger gay men in these respects. The authors conclude that characteristics and care needs of the older HIV-positive population are very diverse and vary sharply by exposure route. Interventions need to be tailored to the needs of these distinct subpopulations, with an emphasis on development of supportive care interventions for older IDUs.
Assessment of quality of life (QoL) in persons living with HIV/AIDS (PLWHA) is becoming crucial to research and evidence-based practice in this area. This paper describes the analysis of the WHOQOL HIV field test instrument, which was given to 1,334 PLWHA from seven culturally diverse centres (Australia, Brazil, Italy, Thailand, Ukraine and two centres in India: Bangalore and New Delhi). The instrument demonstrates good psychometric properties (α values for domains between 0.70 and 0.90) and good discriminant validity, with poorest QoL found for those who reported that they were least well. Men reported poorer physical well-being (F=13.1, p<0.001) and level of independence (F=16.1, p<0.001), while women reported poorer environment (F=25.8, p<0.001), social support (F=11.3, p<0.001) and spirituality (F=7.5, p<0.01). Older people (>34 years) demonstrated poorer QoL on physical (F=20.6, p<0.001) and levels of independence (F=18.3, p<0.001), while younger people showed poorer environmental (F=34.6, p<0.001) and spiritual (F=23.5, p<0.001) domains of well-being. The instrument provides a promising means for QoL assessment for HIV/AIDS in diverse cultural settings.
Objective: To compare the feasibility, reliability, validity and sensitivity to change of the MOS-HIV and MQOL-HIV in order to determine their suitability for use in clinical research.
Methods: Five hundred and fifty-eight HIV-infected patients and 80 healthy blood donors were randomly assigned to receive the MOS-HIV or MQOL-HIV. Test-retest reliability was assessed in 98 clinically stable patients, and responsiveness in 296 patients initiating or switching anti-retroviral treatment. Feasibility was assessed using mean time of administration and percentage of missing responses. Reliability was assessed using Cronbach‚s agr; and the intraclass correlation coefficient (ICC). Construct validity was assessed by correlating questionnaire scores with EuroQol-5D scores, number of symptoms, CD4 cell count and viral load. The area under the curve (AUC) was used for discrimination between patients and healthy donors, and HRQoL scores were compared across disease stage. Responsiveness was assessed by calculating the standardized effect size (SES).
Results: Mean administration time was 16 minutes for both questionnaires. On the MOS-HIV 18.9% patients had missing responses compared with 33.6% on the MQOL-HIV. Cronbach‚s agr; values were higher for MOS-HIV sub-scales (0.78-0.89) than MQOL-HIV sub-scales (0.44-0.82), and neither instrument showed good test-retest reliability (ICC values of 0.24-0.85 for MOS-HIV versus 0.48-0.82 for MQOL-HIV). AUC values for the MOS-HIV were 0.6-0.86, compared with 0.5-0.79 for the MQOL-HIV, and the MOS-HIV had higher correlations with symptoms _(r_=_-0.28 to 0.79) and EuroQol scores (r_=_0.4-0.66) than the MQOL-HIV _(r_=_-0.15 to 0.42 and r_=_-0.11 to 0.59, respectively). Neither instrument discriminated well between disease stages. Eight of 11 MOS-HIV sub-scales and the Mental Health Summary Score were responsive to change (SES, 0.18-0.36), compared with six of 10 MQOL-HIV sub-scales and MQOL Index (SES, 0.16-0.27).
Conclusions: Neither instrument demonstrated completely satisfactory psychometric properties for use in clinical research, although the MOS-HIV performed slightly better on feasibility and validity and the MQOL-HIV on test-retest reliability.
Background/Objective
Having a serious illness such as HIV/AIDS raises existential issues, which are potentially manifested as changes in religiousness and spirituality. The objective of this study was (1) to describe changes in religiousness and spirituality of people with HIV/AIDS, and (2) to determine if these changes differed by sex and race.
Methods
Three-hundred and forty-seven adults with HIV/AIDS from 4 sites were asked demographic, clinical, and religious/spiritual questions. Six religious/spiritual questions assessed personal and social domains of religiousness and spirituality.
Results
Eighty-eight participants (25%) reported being “more religious” and 142 (41%) reported being “more spiritual” since being diagnosed with HIV/AIDS. Approximately 1 in 4 participants also reported that they felt more alienated by a religious group since their HIV/AIDS diagnosis and approximately 1 in 10 reported changing their place of religious worship because of HIV/AIDS. A total of 174 participants (50%) believed that their religiousness/spirituality helped them live longer. Fewer Caucasians than African Americans reported becoming more spiritual since their HIV/AIDS diagnosis (37% vs 52%, respectively; P<0.15), more Caucasians than African Americans felt alienated from religious communities (44% vs 21%, respectively: P<0.01), and fewer Caucasians than African Americans believed that their religiousness/spirituality helped them live longer (41% vs 68% respectively: P<0.01). There were no significantly different reported changes in religious and spiritual experiences by sex.
Conclusions
Many participants report having become more spiritual or religious since contracting HIV/AIDS, though many have felt alienated by a religious group—some to the point of changing their place of worship. Clinicians conducting spiritual assessments should be aware that changes in religious and spiritual experiences attributed to HIV/AIDS might differ between Caucasian and African Americans.
Our study examined differences in HIV-related coping in relation to depression in men and women. Ethnically diverse participants
(n=247, 46% women) were recruited in Dallas/Fort Worth and completed medical and demographic information, the Coping with
HIV Scale (CHIV), and the Center for Epidemiological Studies-Depression scale (CES-D). Multiple regression analyses revealed
that in men, depression was associated with symptoms, higher use of distraction, blame, expression and lower use of positive
growth. In women, depression was associated with symptoms and higher use of blame. These results shed light on the ways in
which each gender copes with HIV and may help researchers develop interventions tailored to the needs of the HIV-positive
population.
KeywordsGender-HIV/AIDS-Coping-Depression
Despite advances in HIV treatment, there continues to be great variability in the progression of this disease. This paper reviews the evidence that depression, stressful life events, and trauma account for some of the variation in HIV disease course. Longitudinal studies both before and after the advent of highly active antiretroviral therapies (HAART) are reviewed. To ensure a complete review, PubMed was searched for all English language articles from January 1990 to July 2007. We found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality. More research is warranted to investigate biological and behavioral mediators of these psychoimmune relationships, and the types of interventions that might mitigate the negative health impact of chronic depression and trauma. Given the high rates of depression and past trauma in persons living with HIV/AIDS, it is important for healthcare providers to address these problems as part of standard HIV care.
The assessment of quality of life (QOL) in HIV infection has emerged as being vital to research and clinical practice. This assessment is also a challenge due to the specific characteristics of the infection, the increased availability of therapeutics, as well as the epidemiological variability inherent to HIV infection. The purpose of this study was to investigate the psychometric properties of the European Portuguese version of the World Health Organization's QOL Instrument in HIV Infection (WHOQOL-HIV) and to test its performance in a sample of HIV-infected patients. The European Portuguese version of WHOQOL-HIV was administered in a sample of 200 HIV-positive patients. The patients also completed the Portuguese versions of Beck Depression Inventory (BDI) and Brief Symptom Inventory (BSI). The WHOQOL-HIV showed quite an acceptable internal consistency (Cronbach's α ranged from 0.86 to 0.95 across domains). Convergent validity with BDI and BSI was satisfactory for all domains (all r>0.50; p<0.001). Moreover, correlations between domains and between domains and overall QOL were all statistically significant (p<0.001). The reliability and validity studies of the European Portuguese version of the WHOQOL-HIV revealed good psychometric characteristics, which allows for the use of this version of WHOQOL in our country, and cross-cultural comparability.
Health-related quality of life (HRQOL) is linked to symptom status and may be related to age in HIV-positive persons. Data were collected in a multisite HIV-positive sample (N = 1,217) using an HIV-specific HRQOL and three symptom status instruments according to the Wilson and Cleary HRQOL model. Multiple stepwise linear regression analysis found that younger age predicted higher sexual function (ΔR(2) = .12, p < .01) and older age predicted greater provider trust (ΔR(2) = .04, p < .01). No significant differences were found in symptom status or the other seven HRQOL dimensions. Although older HIV-positive persons reported more comorbidities, they did not report more symptoms.
Little systematic research has been conducted on the extent of psychiatric disorders among South African patients in general, and among patients living with HIV in particular. The present study reports on a survey conducted among 85 patients receiving treatment at three HIV clinics in the Western Cape. Participants completed the Hopkins Symptom Checklist (HSCL) and the Beck Depression Inventory (BDI), two self-report instruments designed to measure mood disturbance. The mean score of the sample on the HSCL was 47.54, which was significantly different from the commonly used cut-point of 44 for clinically significant distress; 52.9% of the sample scored in the elevated range on this measure. On the BDI, 37.6% of the sample fell in or above the moderate range for depression. The results suggest that a considerable proportion of the sample may be experiencing psychiatric difficulty, for which they may not be receiving treatment.
The need for a validated quality of life (QOL) model focussing on people living with HIV/AIDS has led to an international re-evaluation and extension of the Chronic Illness Quality of Life model using complex latent modelling techniques. After reoperationalising six model variables and including independence and sex-life, the WHOQOL-HIV was administered to 1281 people with asymptomatic-HIV (42%), symptomatic-HIV (40%) or AIDS (18%; 34 years; 62% male) living in Australia, Brazil, India (north & south), Italy, Thailand and Ukraine. The overall model fit was acceptable. Social inclusion did not directly improve QOL, but increased positive feelings, social support and perceived improvements of access to health and social care; all three improved QOL. Social inclusion increased perceived physical health indirectly through positive feelings. Better physical health improved sex-life and gave greater independence; both improved QOL. Gender and disease stage models were acceptable, fitting best for men and asymptomatic-HIV. Similar aspects of QOL were depleted for women and some disease stages. Increased social support did not consistently improve independence or positive feelings. Positive feelings improved the sex-life of men and those with asymptomatic-HIV. This cross-cultural approach combining assessment with theory, could guide future international interventions and practice.
International studies suggesting that 20-37% of HIV-positive patients have diagnosable depression may underestimate the prevalence of this condition. The aim of this study was to investigate the prevalence of depression among HIV-positive patients in an out-patient clinic in Denmark and to detect factors of importance for the development of depression.
In 2005, a population of 205 HIV-positive patients was included in a questionnaire-based study. The Beck Depression Inventory II (BDI-II) was used to assess the prevalence and severity of depressive symptoms. Patients with a BDI score of 20 or above were offered a clinical evaluation by a consultant psychiatrist.
Symptoms of depression (BDI>14) were observed in 77 (38%) patients and symptoms of major depression (BDI>or=20) in 53 (26%). Eighteen patients subsequently started treatment with anti-depressants. In a reduced logistic regression model, self-reported stress, loneliness, constant thoughts about HIV and being in a difficult financial situation were associated with risk of depression. Patients at risk of major depression were nearly six times more likely to have missed at least one dose of highly active antiretroviral therapy (HAART) in the 4 days prior to assessment (odds ratio 5.7, 95% confidence interval 1.7-18.6). There was a dose-response trend in relation to unsafe sex (P=0.03).
The study found that depression was under-diagnosed among HIV-positive patients and was associated with stress, loneliness, a difficult financial situation, low adherence and unsafe sex. Screening for depression should be conducted regularly to provide full evaluation and relevant psychiatric treatment. This is particularly important at the time of diagnosis and before initiating HAART.
This study sought to examine gender-based differences in the quality of life of men and women living with HIV in South India in the era prior to greater access to antiretroviral therapy. The participants in this prospective longitudinal study consisted of 215 men and 141 women who were administered a quality of life (QOL) instrument comprising five scales: physical well-being, psychosocial well-being, sexual well-being, satisfaction with health care, and strength of partner relationship. Interviews were conducted at enrollment and at 6 months in clinical care. Men and women reported similar scores in physical well-being, satisfaction with health care, and relationship with partner from the period prior to care, at enrollment, and at 6 months. Women scored significantly lower than men in psychosocial well-being from the period prior to care, at enrollment, and at 6 months (p < 0.05); women reported significantly higher levels of partner satisfaction at 6 months (p < 0.05). In light of the increasing feminization of the HIV epidemic in India, greater emphasis should be placed on examining the long-term experiences of Indian women living with HIV/AIDS, particularly their psychosocial well-being.
Older adults make up an ever-growing proportion of human immunodeficiency virus (HIV) cases in the United States, with approximately 25% of infections occurring in adults over the age of 50 years. Although there is a preliminary body of literature addressing the socioeconomic and prognostic issues of HIV infection in older adults, very little rigorous scientific research has looked at the significant clinical issues relevant to this growing population. Treatment of older adults is complicated by an increased prevalence of medical comorbidities, but little is known about the effects of complicated medication regimens in this group, as they are routinely excluded from clinical trials of newer HIV medications. The delay in diagnosis and treatment of HIV in older adults has led to poorer outcomes, including lower baseline CD4 counts, decreased time to acquired immune deficiency syndrome diagnosis, and increased mortality. Despite these facts, there is mounting evidence that timely diagnosis and treatment of HIV in older adults leads to improved outcomes, similar to younger patients. This review evaluates the literature focusing on HIV and older adults.
In order to determine the effect of family support on the psychological well-being of heterosexual couples with at least one HIV-seropositive, family support data were obtained from couples, who were separately interviewed. Two hundred heterosexuals were interviewed (97 males, 103 females). 182 were partners in HIV serodiscordant couples (18 members were in 10 couples concordant for HIV-seropositivity). Overall, there were 76 HIV+ males and 30 HIV+ females. The Brief Symptom Inventory (BSI) was used to measure psychological distress. Sixty-five per cent of the subjects had family members aware of partners' HIV infection, but only 50% of aware families were reported as supportive. Family support was not a significant predictor of distress. Gender was the most significant predictor of psychological distress as measured by the BSI subscales. Both HIV positive and HIV negative females had more distress than their male counterparts on several dimensions (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, phobic anxiety and paranoia), and on the General Severity Index (GSI) of the BSI (HIV-positives: p = 0.003; HIV-negatives: p = 0.01). Despite the general lack of association of family support with psychological distress, women in couples affected by HIV had more distress than men. The mental health needs of women clearly differ from men, and continued gender comparisons should be done to develop appropriate and effective interventions for these groups.
One in 10 persons with AIDS is 50 years of age or older. Yet nurses often fail to identify elders with HIV. Here's how to spot these patients and meet their special care needs.
More than 60,000 women in the United States have been diagnosed with AIDS, and millions of women worldwide are infected with
HIV. Most of these women will die at an early age, leaving their children motherless. During their HIV illness, women confront
the challenge of being both patient and family caregiver. Little research has explored this dual challenge. The authors conducted
semistructured one-hour interviews with HIV-positive women that focused on the impact of the HIV diagnosis on the women's
lives. Significant factors emerging from the interviews included the impact of stigma associated with HIV/AIDS, disbelief
of the diagnosis, the lack of a guardian for their children, the paucity of women's support groups, and barriers associated
with seeking services. All women exhibited evidence of clinical depression. A model for multidisciplinary intervention is
proposed that focuses on women's needs within their family systems.
The authors administered the Medical Outcomes Study (MOS 20) Short Form Health Survey to 369 persons with HIV disease. The MOS survey measures six domains of health: physical function, role function, social function, mental health, health perception, and pain. Additional data included sociodemographics, HIV risk group, time since HIV diagnosis, symptoms (dyspnea, diarrhea, fever, chills, sweats, weight loss, weakness, numbness, memory trouble, seizures), and CD4 lymphocyte count within 3 months of the MOS survey. Bivariate analyses revealed worse MOS scores associated with older age in five health domains: physical function (p less than .01), health perception (p <.10), role function (n.s.), social function (n.s.), and mental health (n.s.). Older subjects reported less pain. When controlling for CD4 count and for sociodemographic and clinical variables, older age was significantly (p less than .05) associated with worse MOS scores in physical function, social function, and health perception, nonsignificantly associated with worse MOS scores in role function and mental health, and nonsignificantly associated with less reporting of pain.
We aimed to determine whether the quality of life (QOL) in the patients infected with human immunodeficiency virus (HIV) infection was influenced by satisfaction with social support, coping style and hopelessness. One hundred and thirty-eight HIV-infected patients were prospectively studied in this multicentre, longitudinal study. The QOL was assessed by Medical Outcome Study Health Survey SF-36, social support by Sarason Social Support Questionnaire, hopelessness by Beck Hopelessness Scale, and coping by Billing and Moos Inventory of coping with illness. The QOL did not correlate with age, sex, race, HIV risk factor, education or marital status. Employment (P=0.0001), higher income (P=0.03), satisfaction with social support (P=0.04), regardless of the source of that support, and problem-focused coping (P=0.03) were associated with a significantly better QOL, while, emotion-focused coping (r=-0.19, P=0.04), avoidant coping (r=0.40, P=0.0001), hopelessness (r=-0.64, P=0.0001) and AIDS (P=0.09) were predictors of poorer QOL. Physical functioning correlated positively with employment (P=0.0001), and inversely with AIDS (P=0.0002), hopelessness (P=0.03), avoidant coping (P=0.03), and age (P=0.10). At 6 months follow up, QOL score had changed in 20% of the patients; older age (P=0.01), and lesser satisfaction with social support (P=0.15) were associated with a decline in QOL, while adherence with antiretroviral therapy (P=0.006) was associated with an increase in QOL score. Seven of 138 patients died during follow up; these patients had significantly lower QOL at baseline than all other patients (P=0.003). Interventions to alleviate hopelessness, maladaptive coping, and enhancement of satisfaction with social support may improve overall QOL in HIV-infected patients. Older patients with HIV were less satisfied with their social support, were more likely to utilize unhealthy coping styles, and experienced a greater decline in QOL over time.
To compare the feasibility, reliability, validity and sensitivity to change of the MOS-HIV and MQOL-HIV in order to determine their suitability for use in clinical research.
Five hundred and fifty-eight HIV-infected patients and 80 healthy blood donors were randomly assigned to receive the MOS-HIV or MQOL-HIV. Test-retest reliability was assessed in 98 clinically stable patients, and responsiveness in 296 patients initiating or switching anti-retroviral treatment. Feasibility was assessed using mean time of administration and percentage of missing responses. Reliability was assessed using Cronbach's alpha and the intraclass correlation coefficient (ICC). Construct validity was assessed by correlating questionnaire scores with EuroQol-5D scores, number of symptoms, CD4 cell count and viral load. The area under the curve (AUC) was used for discrimination between patients and healthy donors, and HRQoL scores were compared across disease stage. Responsiveness was assessed by calculating the standardized effect size (SES).
Mean administration time was 16 minutes for both questionnaires. On the MOS-HIV 18.9% patients had missing responses compared with 33.6% on the MQOL-HIV. Cronbach's alpha values were higher for MOS-HIV sub-scales (0.78-0.89) than MQOL-HIV sub-scales (0.44-0.82), and neither instrument showed good test-retest reliability (ICC values of 0.24-0.85 for MOS-HIV versus 0.48-0.82 for MQOL-HIV). AUC values for the MOS-HIV were 0.6-0.86, compared with 0.5-0.79 for the MQOL-HIV, and the MOS-HIV had higher correlations with symptoms (r = -0.28 to 0.79) and EuroQol scores (r = 0.4-0.66) than the MQOL-HIV (r = -0.15 to 0.42 and r = -0.11 to 0.59, respectively). Neither instrument discriminated well between disease stages. Eight of 11 MOS-HIV sub-scales and the Mental Health Summary Score were responsive to change (SES, 0.18-0.36), compared with six of 10 MQOL-HIV sub-scales and MQOL Index (SES, 0.16-0.27).
Neither instrument demonstrated completely satisfactory psychometric properties for use in clinical research, although the MOS-HIV performed slightly better on feasibility and validity and the MQOL-HIV on test-retest reliability.
To examine the effect of HIV status, symptomatology and CD4+ lymphocyte level on health-related quality of life, the Medical Outcomes Study Short-Form Health Survey (SF-36) was administered to 2,295 gay men enrolled in the Multicenter AIDS Cohort Study (MACS) in 1994. Distinct physical and mental health factors of the SF-36 were found. Seropositive asymptomatic individuals and seropositive individuals with CD4+ lymphocytes > or = 500/mm3 scored as well as seronegative participants on all of the mental health domain scales, but lower on the general health perceptions and physical health composite score. Seropositive individuals with at least one symptom or with CD4+ lymphocytes below 200/mm3 scored significantly lower on all of the SF-36 scales and summary scores than seronegative controls. The SF-36 was found to exhibit similar mental and physical health factors for an adult gay male population to that previously seen in general population samples and in patient groups with other diseases. In conclusion, HIV-positive men who are asymptomatic or have CD4+ lymphocytes above 500/mm3 have similar perceived mental health but worse perceived physical health than seronegative men. HIV-positive men who are symptomatic or have CD4+ lymphocytes below 200/mm3 have worse perceived mental and physical health than seronegative men.
This article explores how a group of human immunodeficiency virus (HIV)-infected patients perceived their health-related quality of life (HRQOL) in relation to their coping capacity expressed as sense of coherence. The emphasis was on gender differences. The sample consisted of 55 women (29%) and 134 men (71%), receiving outpatient medical care in a hospital. Self-report instruments, the health index, the HIV symptom scale, the well-being scale, the sense of coherence (SOC) scale and the Interview Schedule for Social Interaction were used. Disease status (HIV CDC classification, absolute CD4+ lymphocyte count and HIV/RNA) was also measured, and demographic data were collected. The total sample scored significantly worse self-rated health and weaker SOC than healthy controls. The HIV-infected women were significantly younger than the men (p < 0.0001). The majority of the women (60%) were infected by heterosexual transmission and of the men (58%) by homosexual/bisexual contacts. In the univariate analysis the women scored significantly less positive well-being (p < 0.05), weaker SOC (p < 0.05), and less social support (p < 0.01) than the men despite less advanced disease. Multiple regression analyses revealed that SOC was the strongest predictor of subjective HRQOL in both genders. The results suggest that health professionals who individualize their care of HIV-infected patients should try to be sensitive to the different ways in which men and women express their HRQOL.
While much work has been completed in relation to measuring and defining the varying dimensions of quality of life in HIV/AIDS, very little research attention has been directed toward identifying factors that influence or enhance quality of life.
This study examined whether variables relating to demographic characteristics, severity of illness, psychological status, or level of engagement in nursing care would predict quality of life in persons with advanced or late stage HIV/AIDS.
A convenience sample of 162 hospitalized male and female patients with AIDS participated in this study. The participants completed the HIV Symptom Checklist, the Beck Depression Inventory, the HIV-QAM (a measure of changes in the status of hospitalized AIDS patients due to nursing care), and two measures of engagement in nursing care. The Living With HIV Scale was used as the measure of quality of life. The two components of this scale were analyzed independently.
The strongest predictor of decreased quality of life scores was depression (accounting for 23% of the variance), with symptoms accounting for 9.75% and female gender accounting for an additional 8%. Two measures of patient engagement with nursing care providers contributed a total of 13.44% of the variance in quality of life scores.
The findings emphasize the importance of recognizing and treating depression in persons with HIV/AIDS. The number of symptoms and their frequency also has a profound effect on quality of life. Although modest, study findings suggest that quality of life for an acutely ill, hospitalized patient with AIDS is enhanced through more active involvement or engagement in the process of nursing care.
Each of 10 published studies investigating the relationship between HIV infection and risk for depressive disorders concluded that HIV-positive individuals are at no greater risk for depression than comparable HIV-negative individuals. This study used meta-analytic techniques to further examine the relationship between depressive disorders and HIV infection.
Meta-analytic techniques were used to aggregate and reanalyze the data from 10 studies that compared HIV-positive and HIV-negative individuals for rates of major depressive disorder (N=2,596) or dysthymic disorder (N=1,822).
The frequency of major depressive disorder was nearly two times higher in HIV-positive subjects than in HIV-negative comparison subjects. On the other hand, findings were inconclusive with regard to dysthymic disorder. Rates of depression do not appear to be related to the sexual orientation or disease stage of infected individuals.
Although the majority of HIV-positive individuals appear to be psychologically resilient, this meta-analysis provides strong evidence that HIV infection is associated with a greater risk for major depressive disorder. Future research should focus on identifying pathways of risk and resilience for depression within this population.
This study prospectively evaluated the effect of treatment of major depression on psychosocial functioning (health-related quality of life (HRQoL)). Previously, we reported on a trial of 75 HIV+ patients who were blindly randomized to receive treatment with drug or placebo (N=25 to each of paroxetine, imipramine, or placebo). Forty-one individuals completed the entire trial (placebo = 14, antidepressant = 27). In this study, we assessed HRQoL using the Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ) and the Social Adjustment Scale (SAS) at baseline and the end of the trial (12 weeks) using a random effects model to estimate treatment effects. HIV/AIDS patients with a major depressive disorder who completed the clinical trial demonstrated a reduction in depression with response to treatment and a significant improvement in HRQoL with the exception of work and financial functioning. Effective management of depression in HIV/AIDS patients is important, especially with the importance of adherence in current HIV/AIDS antiviral therapy. HRQoL improved in patients regardless of drug or response group and as a function of being in this trial suggesting that medications may not be required to affect HRQoL outcomes and that disease management aspects of care are important.
QoL assessment is currently considered essential for clinical trials in HIV infection, as commonly used end-points (CD4 level, viral load, opportunistic diseases) are inadequate to catch the complexity of treatment outcomes. The World Health Organization has recently developed a standardized set of instruments to assess subjective quality of life (QoL) in different medical conditions, including HIV infection. Here we report evidence for the acceptability, reliability and validity of the Italian version of the WHOQOL-HIV. The Italian version of WHOQOL-HIV has been administered in a sample of 151 HIV-positive persons, consecutively attending the largest infectious diseases hospital in southern Italy. Mean time of administration and percentage of missing responses, Cronbach alpha, Pearson coefficient and oneway ANOVA were applied to assess, respectively, acceptability, reliability, convergent and disciminant validity, and sensitivity to change. Mean time of administration was 28 minutes; only 2 questionnaires showed more than 20% of missing responses. Cronbach alpha was above 0.70 in 22 of the 28 sections of the WHOQOL-HIV; it ranged between 0.53 and 0.68 in the remaining 6 sections. Each of the 7 QoL principal domains correlated with overall QoL at a significance level p < 0.001. Moreover, correlation between principal domains were always statistically significant (p < 0.01) with only two exceptions. Finally, mean scores in each QoL domain were in the expected direction (worse in AIDS patients as compared to asymptomatic and symptomatic persons). The Italian version of WHOQOL-HIV is a valid and reliable instrument to assess subjective QoL in HIV-positive persons. It seems potentially useful to assess patients' life satisfaction, and to calibrate standards of care in different stages of the infection.
The purpose of this paper is to assess sexual behaviours which place heroin sniffers (HSs) at high risk for HIV infection. A stratified network-based sample was used to recruit HSs who had no history of injection drug use was recruited from the streets of South Florida, USA. HSs displayed a high HIV seroprevalence rate of 12.1%; women (18.1%) were more likely than men (8.7%) to test positive for HIV. Both men and women HSs engaged in considerable high risk sex behaviour, including high risk sex-exchange behaviour. The use of crack cocaine was associated with increased sex exchange behaviour among women. The need for intervention programs targeted toward HSs is discussed.
To understand the relationship of viral load (VL), CD4 counts, and highly active antiretroviral therapy (HAART) use to health-related quality of life (HRQL).
Cross-sectional analysis of 513 HIV-infected patients. Primary outcomes were four domains of HRQL: physical functioning (PF), role function (RF), energy levels (EL), and health perceptions (HP). The authors examined univariate and multivariate relationships between VL, CD4, and HAART use to each HRQL domain, after adjustment for potential confounders.
In univariate analyses, compared with patients with CD4 > 500, those with CD4 < 200 (p =.001) or 200 to 500 (p =.002) had lower PF and RF scores, and patients with undetectable VL had higher PF scores than patients with VL log10 2.6 to 4.0 (p =.02) and > log10 4.0 (p =.01). In multivariate analyses, compared with patients with CD4 > 500, patients with CD4 < 200 had lower PF (-8.8 points; p <.01), RF (-9.3 points; p <.01), and HP (-7.8 points; p <.001). Patients with log10 VL 2.6 to 4.0 had lower PF scores (-7.7 points; p <.01) versus undetectable VL. After adjusting for VL and CD4 counts, HAART use was associated with lower PF scores (-5.4 points; p <.05).
Efforts to improve patients' CD4 counts are likely to also improve HRQL. Lowering viral loads may improve physical functioning, but only if VL are suppressed to undetectable levels. In this analysis, HAART had negative effects on PF that were independent of its effects on CD4 and VL. For adherent patients, these adverse effects of HAART on PF are likely to be outweighed by the positive effects that HAART exerts through lowering VL and increasing CD4 counts.
The need to address the role of employment in the psychosocial adjustment of persons with HIV/ AIDS has been consistently recognized in the clinical care and research literature. In this study, 200 volunteer HIV/AIDS patients completed questionnaires assessing medical and vocational histories, quality of life, and psychological functioning. Employed and unemployed participants did not significantly differ in terms of gender, education level, ethnicity, prevalence of diagnosed psychiatric and substance use disorders, or overall level of psychological functioning. However, with HIV illness severity statistically controlled, employed participants reported significantly higher overall quality of life.
Symptom recognition is critical for patient care but has been little studied in older HIV-infected individuals. The authors examined differences in symptom expression between younger (younger than age 50 years) and older (older than age 50 years) HIV-infected individuals. The authors analyzed data from two cross-sectional studies of HIV-infected individuals: 2864 individuals from the HIV Cost and Service Utilization Study (HCSUS) and 881 individuals from the Veterans Aging Cohort 3 Site Study (VACS 3). The authors compared the prevalence of eight symptoms common to both studies and 10 symptoms examined only in the VACS 3 population, stratified by age and race. Disease severity was assessed by CD4 count and 18 HIV-related diseases reported. Multivariate logistic regression models were used to account for demographics and severity differences. VACS 3 versus HCSUS participants were more likely nonwhite and older. In unadjusted comparisons, older nonwhites were less likely to report experiencing symptoms than younger whites. They reported the fewest total number of symptoms and the fewest individual symptoms common to both studies (headache, fever, nausea/vomiting, and diarrhea) or in the VACS 3 only (dizziness, sleeping difficulty, fatigue, rashes, bloating, and myalgias/arthalgias). Multivariate regression estimates suggest older age predicts a greater likelihood of reporting peripheral neuropathy, weight loss, or hair loss, but a lower likelihood of reporting headaches, depressed mood, white oral patches, or diarrhea. Nonwhites appeared less likely to report symptoms. Age is a determinant of reporting certain symptoms in HIV disease but may be masked or accentuated by other factors such as race.