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| ORIGINAL ARTICLE |
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| Ahead of print publication |
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Revisiting “Do People Living with HIV/AIDS Have Better Quality of Life” – Findings from a cross-sectional study
SR Manjunath1, Ravishekar N Hiremath2, Raj Kumar3, Anurag Khera4, Kasi Viswanath5
1 Classified Specialist (CM), DADH, HQ 54 Inf Div, C/o 56 APO, Bangalore, India
2 Prof and Classified Specialist (CM), SHO Bangalore, India
3 Consultant (CM) and Brig IC Trg, AFMC, Pune, India
4 Senior Advisor (CM), HQ Delhi Area, C/o 56 APO, Amritsar, India
5 Graded Specialist (CM), SHO Amritsar, India
| Date of Submission | 14-May-2022 |
| Date of Decision | 14-Jun-2022 |
| Date of Acceptance | 23-Jun-2022 |
| Date of Web Publication | 05-Oct-2022 |
Correspondence Address:
SR Manjunath,
Department of Community Medicine, Classified Specialist (PSM), DADH, HQ 54 Inf Div, C/o 56 APO
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jmms.jmms_77_22
Introduction: HIV/AIDS is a challenging disease affecting multiple facets of life. From being a communicable disease alone, it is now posing mental health problems and adjustment disorders as the longevity of HIV/AIDS patients is increasing. In the present study, the quality of life (QOL) among HIV patients was studied, in physical, psychological, environmental, and social domains using the World Health Organization Quality-of-Life Scale (WHOQOL-BREF). Methodology: A cross-sectional, observational study was conducted to assess QOL among 140 randomly selected HIV/AIDS patients attending an antiretroviral therapy (ART) center. The WHO QOL BREF questionnaire was used as a tool for collecting data. Results: The overall QOL among people living with HIV/AIDS (PLWHA) was 14.29 (±1.9), with the highest mean score in social domain with a mean of 15.42 (±2.73) and the lowest in physical domain with a mean of 14.01 (±2.73). A statistically significant association was found between age, gender, place of residence, disclosure status, and overall QOL. PLWHA with high CD4 count and patients on ART had better QOL. Conclusion: Overall QOL in PLWHAs is comparable with other countries, indicating the success of National AIDS Control Programme. Few aspects, if incorporated, can increase further improve QOL among HIV patients.
Keywords: Antiretroviral therapy center, HIV/AIDS, National AIDS Control Programme India, quality of life, World Health Organization
How to cite this URL:
Manjunath S R, Hiremath RN, Kumar R, Khera A, Viswanath K. Revisiting “Do People Living with HIV/AIDS Have Better Quality of Life” – Findings from a cross-sectional study. J Mar Med Soc [Epub ahead of print] [cited 2023 Mar 26]. Available from: https://www.marinemedicalsociety.in/preprintarticle.asp?id=357924 |
| Introduction | |  |
AIDS was first identified in 1981 in the USA among homosexual men.[1] It has emerged as an unprecedented pandemic cutting across boundaries.[2] Based on the available data, the World Health Organization (WHO) had estimated 38.0 million people living with HIV at the end of 2019.[3] Based on HIV Sentinel Surveillance Report 2019, in India, there were an estimated 23.49 lakh (17.98–30.98 lakh) people living with HIV/AIDS (PLWHA) in 2019, with an adult (15–49 years) HIV prevalence of 0.22% (0.17%–0.29%).[4] HIV/AIDS has taken a toll in the world and is expected to cause more economic burden in future. The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support is estimated to be US$22 billion in 2015 and growing.[5]
Patients with HIV/AIDS are at an increased risk of psychiatric illness such as depression, anxiety, personality disorders, adjustment disorders, and suicidal tendencies. Households affected by HIV/AIDS bear a substantial burden of illness and death and associated severe poverty.[6],[7],[8] Recent treatment advances and combination antiretroviral therapy (ART) with array of health services and social support services to PLWHAs have prolonged life and created new challenges.[9],[10] Quality of life (QOL) refers to people's subjective evaluation of the influence of their health status, healthcare, and health-promoting activities on their ability to achieve and maintain a level of overall functioning that allows them to pursue valued life goals and that is reflected in their general well-being.[11] WHO QOL tool has been used to measure QOL in other chronic diseases and has helped in identifying the affected domains for implementing appropriate interventions. The data on QOL among HIV/AIDS patients in certain ART centers of northern India are lacking. Hence, a study was planned with an objective to access QOL among HIV/AIDS patients in an ART center and to identify the factors affecting the QOL.
| Methodology | | |
A cross-sectional observational study was carried out among PLWHA in northern India.
Sample size and sampling technique
Sample size was calculated for estimating 95% confidence interval with relative error of margin 5% of the mean. A sample size of 135 was maximum for the physical domain (mean 11.96 and standard deviation 3.5).[12] Hence, 140 HIV/AIDS patients were studied. Systematic random sampling was used to select the eligible subjects. From the starting date of data collection, all eligible patients who reported were assigned numbers. The first patient was randomly selected between 1 and K (K = 4500/135 = 33). Thereafter, every Kth subject from the above series was included in the study till the sample size achieved. If the patient was included in earlier visit, he/she was excluded and the next patient in the series was included.
Inclusion criteria
Only patients registered with ART center and aged 18 years and above were included in study.
Exclusion criteria
Severely ill patients (HIV/AIDS Stage IV) were excluded from the study.
Data collection methods
Data were collected using an interviewer-administered WHO BREF QOL questionnaire.[13] Data on sociodemographic profile and HIV status-related data were also collected.
World Health Organization Quality of Life BREF Questionnaire
WHO QOL BREF is a short version of WHO QOL 100. In contrast to WHO QOL 100, it consists of 26 questions. The WHO QOL BREF consists of four domains, namely physical, psychological, social, and environmental.[14] Each question was measured by 5-point Likert scale. Scores in the WHO QOL BREF ranged from 26 to 130. The QOL was determined by dividing the scores into three groups: low, moderate, and high.
Statistical analysis
The data were entered in MS Office Excel Sheet and analyzed using SPSS statistics for windows, version 19. 0 (SPSS Inc., Chicago, Ill., USA) Descriptive statistics such as mean and percentage were applied for each of the domains of QOL; normality test, Kolmogorov–Smirnov test, test for homogeneity, Student's unpaired t-test, ANOVA, and Kruskal–Wallis test were also applied to test domains of QOL and subgroups. Ethical clearance was taken from the institutional ethics committee.
| Results | | |
A total of 140 HIV/AIDS patients registered in the ART center of a tertiary care center were studied. Majority of the study participants were females (55%), with a mean age being 38.73 (±9.23) years and a range of 18–65 years, and majority of the subjects had done their secondary schooling (60%). Maximum study participants were unskilled/semiskilled workers and were earning between Rs. 1547 and 5155 (30.7%), were residing in urban area (60%), and were married (72.9%) [Table 1].
Maximum study participants were heterosexuals (87.1%), and 60.7% had disclosed their HIV status to their families. Among the individuals who have disclosed their status, 55% had disclosed it only to their partners. 53.6% of the participants had at least one HIV-positive member in family. 76.4% were on ART [Table 2]. The overall QOL among PLWHA was 14.29 (±1.9), with the highest mean score in social domain with a mean of 15.42 (±2.73) and the lowest in physical domain with a mean of 14.01 (±2.73) [Table 3]. Younger participants had better QOL than elderly, and a statistically significant association was found in physical domain, psychological domain, and overall QOL (P < 0.05) in different age groups. Males had better QOL than females in physical, psychological, and environmental domains and overall QOL (P < 0.05). PLWHAs residing in urban areas, those who have disclosed their HIV status to family members, and those on ART at the time of the study had better overall QOL [Table 4]. | Table 4: Association between sociodemographic profile and quality of life
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| Discussion | | |
The present study has established QOL among HIV/AIDS patients and its association with various other factors among HIV/AIDS patients. The study has brought out many significant and relevant findings and reinforced many known facts. The sociodemographic profile of the study participants [Table 1] was comparable to other studies carried out in India.[13] Among 140 participants, 55% were females, and majority were married, staying in urban area, heterosexual, and at least one more member with HIV/AIDS. Participants were living with HIV for a maximal period of 20 years; however, PLWHA for <5 years were more compared to PLWHA for >5 years. Majority of the individuals had disclosed HIV status; however, it is still less compared to other studies, reflecting the fear and stigma of HIV in society. This calls for counseling at ART centers for encouraging individuals' status to be disclosed to family members. In the present study, social domain score is highest compared to other domains, and this is in consistent with other studied carried out in India, which can be interpreted for better support from the partner and family of patients,[13],[15],[16] but contrary to a study carried out by Nirmal et al. where score was highest for the environmental domain.[17]
In the present study, elderly patients had low overall QOL and more so in the psychological domain which was statistically significant. A study conducted by Piette et al. that among HIV-positive patients, older age was significantly associated with worse physical functioning due to decline in physical and psychological status, which is consistent with our results.[18]
In the present study, female patients had low overall QOL. In a study conducted by Kohli et al. and Mrus et al. in the USA, females reported lower QOL scores than males.[19],[20] Gender inequality is one of the important factors present across globe, which shows that there are gender differences in access to treatment, care, economic income, and social and personal power. Among women's barriers to care are family responsibilities and fear of disclosure. Oguntibeju in his study had reported that patients with higher education reported better QOL, possibly due to better knowledge about their treatment.[21] A study in central Karnataka found that PLWHA residing in urban area showed better mean in physical, psychological, and environmental domains.[22] These results are consistent with the results of the current study. Further, PLWHA who had disclosed their HIV status had better QOL. Similarly, in a study conducted in South India, disclosure of HIV status was significantly associated with higher QOL which is consistent with the present study and can be attributed to the support that patients get from spouse and family members.[23]
There was statistically significant association between having at least one family member with HIV/AIDS and lower QOL score in physical domain (P = 0.015), social domain (P = 0.001), and environmental domain (P = 0.036). This was probably due to more of financial burden on family, decrease physical ability to earn, and also cost of traveling and assessing the healthcare facility. The results of the present study are also consistent with the findings of Tran, Cohen et al., and Jaquet et al., wherein the initiation of highly active antiretroviral therapy was associated with a significant improvement in both physical and mental dimensions of QOL in HIV-positive patients.[24],[25],[26] HIV/AIDS patients who are receiving ART could achieve suppressed viral loads, improved immune and physical functions, and reduced opportunistic infections and comorbidities. In addition, they continue to be productive, more socially inclusive, and have better QOL.
Limitations
The current study was a cross-sectional study, so the temporality cannot be established even though many sociodemographic factors have shown a significant association. The study did not include Stage IV patients as they are known to have low QOL. The scope of the present study was broad based, encompassing manifold issues of QOL of HIV/AIDS patients.
| Conclusion | | |
Apart from being a chronic disease, HIV/AIDS make patients suffer from social problems, such as stigma, out-casting, and noninclusion, making PLWHA stressed and concerned about how to manage their lives. Their physical, mental and social health is always being affected leading to poor QOL due to self esteem problem, poverty, depression, substance abuse, and cultural beliefs. ART centers in India are carrying out a satisfactory service delivery, which can be observed in the present study results. However, more improvement is need of the hour at ART centers. Focused interventions can be directed to individual patients concentrating on the affected domains (physical/psychological/social/environmental domain) if the WHO QOL is administered. This can lead to better service delivery and QOL among PLWHA.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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