• Users Online: 281
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

Ahead of print publication  

Revisiting “Do People Living with HIV/AIDS Have Better Quality of Life” – Findings from a cross-sectional study

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 Submission14-May-2022
Date of Decision14-Jun-2022
Date of Acceptance23-Jun-2022
Date of Web Publication05-Oct-2022

Correspondence Address:
SR Manjunath,
Department of Community Medicine, Classified Specialist (PSM), DADH, HQ 54 Inf Div, C/o 56 APO
Login to access the Email id

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 Top

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 Top

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 Top

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].
Table 1: Sociodemographic profile of people living with HIV/AIDS

Click here to view

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 2: HIV/AIDS-related data

Click here to view
Table 3: Quality of life among study participants

Click here to view
Table 4: Association between sociodemographic profile and quality of life

Click here to view

  Discussion Top

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.


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 Top

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


Conflicts of interest

There are no conflicts of interest.

  References Top

Agnihotri K, Awasthi S, Chandra H, Singh U, Thakur S. Validation of WHO QOL-BREF instrument in Indian adolescents. Indian J Pediatr 2010;77:381-6.  Back to cited text no. 1
Bhatnagar A, Bhalwar R. The curse of HIV: How well prepared is our paramedical force? Med J Armed Forces India 2005;61:230-3.  Back to cited text no. 2
World Health Organization. Data and Statistics/Fact Sheet/HIV. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids. [Last accessed on 2021 Jun 01].  Back to cited text no. 3
National AIDS Control Organization & ICMR-National Institute of Medical Statistics (2020). India HIV Estimates 2019: Report. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India.  Back to cited text no. 4
Schwartländer B, Stover J, Hallett T, Atun R, Avila C, Gouws E, et al. Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 2011;377:2031-41.  Back to cited text no. 5
Komiti A, Judd F, Grech P, Mijch A, Hoy J, Williams B, et al. Depression in people living with HIV/AIDS attending primary care and outpatient clinics. Aust N Z J Psychiatry 2003;37:70-7.  Back to cited text no. 6
Owe-Larsson M, Säll L, Salamon E, Allgulander C. HIV infection and psychiatric illness. Afr J Psychiatry 2009;12:115-28.  Back to cited text no. 7
Cooperman NA, Simoni JM. Suicidal ideation and attempted suicide among women living with HIV/AIDS. J Behav Med 2005;28:149-56.  Back to cited text no. 8
Palella FJ Jr., Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998;338:853-60.  Back to cited text no. 9
Kumarasamy N, Solomon S, Chaguturu SK, Cecelia AJ, Vallabhaneni S, Flanigan TP, et al. The changing natural history of HIV disease: Before and after the introduction of generic antiretroviral therapy in southern India. Clin Infect Dis 2005;41:1525-8.  Back to cited text no. 10
Shumaker SA, Ellis S, Naughton M. Assessing health-related quality of life in HIV disease: Key measurement issues. Qual Life Res 1997;6:475-80.  Back to cited text no. 11
Wig N, Lekshmi R, Pal H, Ahuja V, Mittal CM, Agarwal SK. The impact of HIV/AIDS on the quality of life: A cross sectional study in north India. Indian J Med Sci 2006;60:3-12.  Back to cited text no. 12
[PUBMED]  [Full text]  
Saxena S, Chandiramani K, Bhargava R. WHOQOL-Hindi: A questionnaire for assessing quality of life in health care settings in India. World Health Organization Quality of Life. Natl Med J India 1998;11:160-5.  Back to cited text no. 13
World Health Organization. WHOQOL-BREF: Introduction, Administration, Scoring and Generic Version of the Assessment: Field trial version, December 1996. World Health Organization; 1996.  Back to cited text no. 14
Imam MH, Karim MR, Ferdous C, Akhter S. Health related quality of life among the people living with HIV. Bangladesh Med Res Counc Bull 2011;37:1-6.  Back to cited text no. 15
Agrawal H, Mourya R, Shrestha RK, Agrawal S. Quality of life among HIV positive individuals in Kathmandu valley and Eastern region of Nepal. Kathmandu Univ Med J (KUMJ) 2012;10:3-7.  Back to cited text no. 16
Nirmal B, Divya K, Dorairaj V, Venkateswaran K. Quality of life in HIV/AIDS patients: A cross-sectional study in south India. Indian J Sex Trans Dis AIDS 2008;29:15.  Back to cited text no. 17
Piette J, Wachtel TJ, Mor V, Mayer K. The impact of age on the quality of life in persons with HIV infection. J Aging Health 1995;7:163-78.  Back to cited text no. 18
Mrus JM, Williams PL, Tsevat J, Cohn SE, Wu AW. Gender differences in health-related quality of life in patients with HIV/AIDS. Qual Life Res 2005;14:479-91.  Back to cited text no. 19
Kohli RM, Sane S, Kumar K, Paranjape RS, Mehendale SM. Assessment of quality of life among HIV-infected persons in Pune, India. Qual Life Res 2005;14:1641-7.  Back to cited text no. 20
Oguntibeju OO. Quality of life of people living with HIV and AIDS and antiretroviral therapy. HIV AIDS (Auckl) 2012;4:117-24.  Back to cited text no. 21
Gowda S, Channabasappa AN, Dhar M, Krishna D. Quality of life in HIV/AIDS patients in relation to CD4 count: A cross-sectional study in Mysore district. Int J Health Allied Sci 2012;1:263.  Back to cited text no. 22
  [Full text]  
Chandra PS, Gandhi C, Satishchandra P, Kamat A, Desai A, Ravi V, et al. Quality of life in HIV subtype C infection among asymptomatic subjects and its association with CD4 counts and viral loads – A study from South India. Qual Life Res 2006;15:1597-605.  Back to cited text no. 23
Cohen C, Revicki DA, Nabulsi A, Sarocco PW, Jiang P. A randomized trial of the effect of ritonavir in maintaining quality of life in advanced HIV disease. Advanced HIV Disease Ritonavir Study Group. AIDS 1998;12:1495-502.  Back to cited text no. 24
Jaquet A, Garanet F, Balestre E, Ekouevi DK, Azani JC, Bognounou R, et al. Antiretroviral treatment and quality of life in Africans living with HIV: 12-month follow-up in Burkina Faso. J Int AIDS Soc 2013;16:18867.  Back to cited text no. 25
Tran BX. Quality of life outcomes of antiretroviral treatment for HIV/AIDS patients in Vietnam. PLoS One 2012;7:e41062.  Back to cited text no. 26


  [Table 1], [Table 2], [Table 3], [Table 4]


     Search Pubmed for
    -  Manjunath S R
    -  Hiremath RN
    -  Kumar R
    -  Khera A
    -  Viswanath K
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Article Tables

 Article Access Statistics
    PDF Downloaded14    

Recommend this journal