Abstract
Human immunodeficiency virus (HIV)/AIDS is a manageable infectious disease by the effectiveness of highly active antiretroviral therapy. AIDS‐related stigma and conflict may create distress and deteriorate quality of life (QoL) of people living with HIV/AIDS (PLWHA). This cross‐sectional, descriptive, correlational study using structural questionnaires aimed to explore the stress, needs, QoL, and associated factors of PLWHA in Taiwan. A total of 200 PLWHA participating in this study needed most on treatment of HIV and prevention of AIDS, and health maintenance. They had worse QoL in physical, psychological, and social domains (all p < 0.001) than the general population. Stress was the most significant predictor (β = −0.25 to −0.54, p < 0.01) for all four domains of QoL. Needs was not significantly associated with QoL. The QoL of PLWHA can be explained by demographics, self‐perception on health, needs, and stress for 25.3–40.7% of variances. No association existed between CD4+ counts and QoL in Taiwanese PLWHA. It is important to recognize the perception of PLWHA on their health status, which is significantly associated with their QoL, besides monitoring their physical indicators of health (CD4+ counts). To recognize the stress and needs that PLWHA experience and to develop intervention programs targeting strategies on HIV disclosure, prevention and health maintenance are crucial for PLWHA's QoL.
Keywords: Needs, People living with human immunodeficiency virus/AIDS, Perception, Quality of life, Stress
Introduction
The number of human immunodeficiency virus (HIV)‐infected people continues to increase worldwide since the first AIDS patient was identified in 1980. However, highly active antiretroviral therapy has significantly reduced the AIDS related mortality rate [1]. HIV infection has become a chronic disease [2].
Quality of life (QoL), a multidimensional concept, is now recognized as a significant indicator for the health and many aspects in the lives of people living with HIV/AIDS (PLWHA) due to the chronicity of AIDS. AIDS stigma and discrimination were found to be significantly related to the QoL of PLWHA in all stages. Compared with noninfected individuals, PLWHA in all disease stages demonstrated a poor QoL in all aspects, especially in psychological and social aspects [[3], [4], [5]]. In literature, the poorer QoL of PLWHA was associated with the more severe disease condition, lower CD4+ T cells count, longer treatment time, poor mental health, no family support, being older, being female, and lower educational and economic levels, although it varied in degree by individual cultural contexts and available medical care in different countries [[6], [7], [8], [9], [10], [11], [12], [13], [14]].
The only report about QoL and stress among Taiwanese PLWHA in 2003 identified that stress was related to mood disturbance, poor social support, physical‐symptom distress, and self‐perceived mode of HIV transmission. The predictor of QoL was the source of financial support [15]. We re‐examined the QoL, stress, and its predictors among Taiwanese PLWHA because of the improvement in AIDS care with time, and the initiation of the case manager service in 2006 and needle exchange program in 2005 might change the stigma of PLWHA, stress, and QoL. Due to the chronicity of AIDS, how to keep PLWHA in the medical system is an important problem. To meet the needs of PLWHA, we need them to stay in the medical system [16]. We believed the importance of stress, needs, and QoL of PLWHA cannot be ignored in the continuing HIV care, and that there is a paucity of only one study to investigate all the three issues. Therefore, we aimed to investigate stress, needs, and QoL of PLWHA and the associated factors of QoL, stress, and needs in Taiwan.
Methods
This cross‐sectional, descriptive, correlational study aimed to explore the associated factors of stress, needs, and QoL among PLWHA in Taiwan (Figure 1). We recruited PLWHA who were aged 18 years or older at the clinics and wards in a medical center in southern Taiwan from January 2009 to January 2010. Approval was obtained from the Institutional Review Board at the researchers' institution. After receiving informed consent from patients, a structured questionnaire was used to collect data.
Figure 1.
The framework of research—quality of life (QoL), stress, and needs.
Measures
The study questionnaire was designed to measure stress, needs, and QoL of PLWHA. The demographic part includes personal information, disease and diagnosis related information, such as family's awareness of patients' diagnosis, reasons for revealing diagnosis to family, relationship with family before and after diagnosis, change or loss of employment, current health status and health change after the diagnosis date, laboratory data (CD4 and HIV viral load), hospitalization history, and routes of opportunistic infections or transmission.
Stress and needs scales were developed for this study. The stress scale, comprising 25 items and divided into five aspects (physical, psychological, economic, social, and limitation in daily life), was constructed based on literature review to measure the stress level in PLWHA. Items were scored using a five‐point scale from 0 (never) to 4 (always). The possible total score ranges from 0 to 100. The higher scores indicate higher perceived stress. The needs scale also consists of 25 items in five aspects (physical, psychological, economic, social, and nutrition and diet). Items were scored using a four‐point scale from 0 (no need) to 3 (very much needed). The possible total score ranges from 0 to 75 with higher scores indicating higher perceived needs. The need source scale is used to evaluate the sources that PLWHA encountered. The scale contained three items including their preferred sources, the preferred methods to meet their needs, and the ways the healthcare workers informed them of their illness. Items were scored using a four‐point scale from 0 (no need) to 3 (very much needed). The content validity indexes based on six experts pointed for the content of the need scale about relevance, correctness, and appropriateness of rated wording from very suitable (4 points) to very inappropriate (1 point). The content validity indexes were 95.7% for the stress scale and 97.7% for the needs scale. A preliminary reliability test was carried out with 50 patients, and the Cronbach α was 0.92 for the stress scale and 0.933 for the needs scale.
Patients' QoL was measured using the WHOQOL‐BREF (World Health Organization Quality of Life), the WHOQOL Taiwan Version [17] with 28 items in four domains. Cronbach α values were 0.91, 0.76, 0.70, 0.72, and 0.77 for the total scale, physical, psychological, social, and environmental domains, respectively. The test–retest reliabilities were >0.75, and the criterion‐related validities ranged from 0.53 to 0.78 (p < 0.01).
Statistical analysis
Descriptive statistics (mean, standard deviation, frequency, and percentage) were used to describe patients' characteristics and variables. Inferential statistics and the Z test were used to examine relationships between variables and comparison of QoL with the general population. Demographic information, education, family structure, CD4+ count, and health status before and after infection, were dummy coded in the regression analyses.
Results
Demographics
A total of 200 PLWHA agreed to participate in this study. Table 1 describes demographic information. The majority were male (96%), single (89%), had a Bachelor of Science (BS) degree or higher (65.5%), with a mean age of 32.7 ± 8.43 years. Thirty‐six (18%) PLWHA had changed jobs due to AIDS‐related issues. Homosexual contact resulted in the most infection (83%). The CD4+ counts of PLWHA were 284.3 ± 224.9 × 106 cells/L, and 37% had a CD4+ count below 200 × 106 cells/L. Eighteen cases (9.0%) had suffered from opportunistic infections, mostly tuberculosis and Pneumocystis jirovecii pneumonia.
Table 1.
Demographics and perception of health, social relationships, and caregivers of people living with human immunodeficiency virus/AIDS.
| Item | n (%) |
|---|---|
| Sex | |
| Male | 192 (96) |
| Female | 8 (4) |
| Marital status | |
| Single | 178 (89) |
| Married | 14 (7) |
| Divorced or separated | 8 (4) |
| Level of education | |
| BS or higher | 131 (65.5) |
| High school | 50 (25) |
| Junior high school or lower | 19 (9.5) |
| Unemployment or change | 36 (18) |
| Family structure | |
| Nuclear family | 162 (81) |
| Stem or extended family | 17 (8.5) |
| Other | 21 (10.5) |
| Hospitalization due to AIDS | 62 (31) |
| CD4+ count ≤ 200 × 106/L | 74 (37) |
| Opportunistic infection | 18 (9) |
| Transmission route | |
| Homosexual contact | 166 (83) |
| Heterosexual contact | 23 (11.5) |
| Bisexual contact | 1 (0.5) |
| Injection drug use | 10 (5) |
| Self perception on health | |
| Poor | 59 (29.5) |
| Average | 83 (41.5) |
| Good and excellent | 68 (34) |
| Self perception of health change | |
| A lot worse | 39 (19.5) |
| Worse | 68 (34) |
| Same | 67 (33.5) |
| Better | 17 (8.5) |
| A lot better | 9 (4.5) |
| Living with family | 118 (59) |
| Family knows the diagnosis | 104 (52) |
| Disclosure reasons | |
| Faith in support | 52 (50) |
| Involuntary by hospitals | 36 (34.6) |
| Involuntary by health department | 9 (8.7) |
| Involuntary by military | 1 (0.9) |
| Missing | 6 (5.8) |
| First to notify | |
| Parents | 72 (69.2) |
| Spouse | 10 (9.6) |
| Siblings | 20 (19.2) |
| Other (partner) | 2 (1.9) |
| Main caregiver | |
| Parents | 85 (42.5) |
| Spouse | 13 (6.5) |
| Siblings | 7 (3.5) |
| Other | 29 (14.5) |
| None | 65 (32.5) |
| Change in relationship with family after disclosure | |
| Better | 19 (9.5) |
| Same | 162 (81) |
| Worse | 19 (9.5) |
BS = Bachelor of Science.
The major family structure for our study was nuclear family (81%). Most (59%) lived with their original family. Fifty‐two percent of family members of PLWHA knew about their diagnosis of HIV. Parents were the largest group as caregivers (63.4%) and the first to whom patients in this study revealed their illness (69.2%). Hospitalization was not associated with HIV disclosure (p > 0.05; Table 2). Changes in the relationship between PLWHA and their families were associated with families being notified about the AIDS status (χ2 = 8.84, p = 0.012). The descriptive information of stress, needs, and four domains of QoL is presented in Table 3.
Table 2.
Testing of mean scores for stress, needs, and four domains of quality of life (n = 200).
| Demographic (yes/no) | Stress | Needs | Quality of life | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Physical health | Psychological health | Social relationships | Environmental | |||||||||
| Mean (y/n) | t | Mean (y/n) | t | Mean (y/n) | t | Mean (y/n) | t | Mean (y/n) | t | Mean (y/n) | t | |
| BS degree or higher | 40.0/43.3 | −1.40 | 46.5/44.9 | 0.83 | 13.9/13.1 | 2.14* | 12.5/11.8 | 1.95 | 13.1/12.4 | 2.04* | 13.8/12.5 | 4.34** |
| Religion | 41.7/40.0 | 0.69 | 46.8/44.2 | 1.36 | 13.5/13.9 | −1.14 | 12.4/11.9 | 1.39 | 13.0/12.7 | 0.68 | 13.3/13.4 | −0.22 |
| Nuclear family | 41.6/39.3 | 0.80 | 46.7/42.7 | 1.75 | 13.6/13.8 | −0.51 | 12.1/12.7 | −1.27 | 12.8/13.3 | −1.27 | 13.2/13.9 | −1.66 |
| Live with family | 42.0/39.9 | 0.91 | 46.8/44.7 | 1.12 | 13.3/14.1 | −2.50* | 12.4/12.1 | 0.66 | 13.0/12.7 | 0.82 | 13.4/13.3 | 0.33 |
| Family knows AIDS status | 42.3/39.9 | 1.05 | 45.7/46.2 | −0.27 | 13.2/14.1 | −2.77* | 12.2/12.3 | −0.38 | 12.6/13.1 | −1.59 | 13.2/13.6 | −1.01 |
| Voluntary disclosure | 41.4/41.1 | 0.13 | 48.0/45.2 | 1.32 | 13.5/13.7 | −0.34 | 12.6/12.1 | 1.23 | 13.1/12.8 | 0.69 | 13.4/13.3 | 0.26 |
| Parent as main caregiver | 40.3/41.8 | −0.67 | 46.2/45.7 | 0.27 | 13.5/13.7 | −0.84 | 12.2/12.3 | −0.03 | 12.8/12.9 | −0.46 | 13.4/13.3 | 0.41 |
| CD4 ≤ 200 × 106/L | 40.2/41.6 | −0.60 | 44.7/46.4 | −0.86 | 13.6/13.7 | −0.24 | 12.4/12.1 | 0.69 | 13.1/12.8 | 0.67 | 13.5/13.2 | .76 |
| Opportunistic infection | 36.8/41.6 | −1.27 | 44.5/46.1 | −0.51 | 12.8/13.7 | −1.51 | 11.8/12.3 | −0.71 | 13.0/12.9 | 0.26 | 13.2/13.4 | −0.40 |
| Hospitalization due to AIDS | 41.6/40.9 | 0.28 | 43.8/46.9 | −1.59 | 12.8/14.0 | −3.41** | 12.2/12.3 | −0.26 | 12.8/12.9 | −0.43 | 13.3/13.4 | −0.34 |
| AIDS‐related unemployment | 47.3/39.8 | 2.07* | 46.5/45.8 | 0.30 | 12.6/13.8 | −2.97** | 11.2/12.5 | −2.77** | 12.0/13.1 | −2.64** | 12.3/13.6 | −3.18** |
| Poor health | 46.8/39.3 | 2.95** | 48.0/39.3 | 1.27 | 11.9/14.2 | −5.45** | 11.2/12.6 | −3.28** | 12.1/13.1 | −2.76** | 12.4/13.7 | −3.59** |
| Deteriorating health | 44.8/37.0 | 3.61** | 46.5/45.3 | 0.69 | 12.7/14.7 | −6.48** | 11.6/13.0 | −4.13** | 12.3/13.5 | −3.92** | 12.8/14.0 | −4.08** |
*p < 0.05; **p < 0.01. The t and p values were compared with/without demographics among stress, need and quality of life.
BS = Bachelor of Science; y/n = yes/no.
Table 3.
Description and Cronbach α of stress, needs, and four domains of quality of life.
| Mean (SD) | Range | α | |
|---|---|---|---|
| Stress | 41.1 (15.81) | 0–91 | 0.92 |
| Needs | 46.0 (14.76) | 4–75 | 0.93 |
| Quality of life | 57.9 (8.80) | 33–82 | 0.91 |
| Physical | 13.6 (2.35) | 6 –19 | 0.76 |
| Psychological | 12.3 (2.63) | 5–19 | 0.70 |
| Social | 12.9 (2.23) | 4–19 | 0.72 |
| Environmental | 13.4 (2.24) | 8–20 | 0.77 |
SD = standard deviation.
Stress
Participants felt most stressful about making their HIV/AIDS status public, not knowing how to tell people about their illness, unpredicted health, being rejected, spreading HIV to family or friends, and family/friends being stigmatized (Table S1).
Needs
Participants indicated a need to know about how to care for the illness. Needs, ranked in order, were: (1) examination and treatment information; (2) health maintenance information; (3) medication side effects information; (4) opportunistic infection prevention; and (5) professional counseling (Table S2).
Sources of needs
Participants were asked about their AIDS‐related information source, the desired means to receive information, and favorable attitudes from physicians when informing them of their illness. The doctor (85%) was most helpful in providing knowledge and information, followed by the nurse (78%), social worker (28.5%), and others. Participants preferred to be informed face‐to‐face by professionals (80%) or by telephone consultation when needed (62.5%). Most patients (68%) expressed a wish not to inform their family when their illness becomes terminal. Moreover, 26.5% believed that AIDS information posted on the Internet provided the greatest help, and 25.5% also wish to obtain AIDS‐related information through the Internet (Table S3).
QoL
The Z test revealed that PLWHA scored significantly lower in physical, psychological, and social domains, but no difference was found in the environmental domain, when compared with the general population. However, family members of PLWHA had significantly lower scores in social and environmental domains than PLWHA. There was no significant difference in physical health and psychological health [18] (Table 4).
Table 4.
Comparison of quality of life of patients with quality of life of family members of people living with human immunodeficiency virus/AIDS (PLWHA) and the general population (Z test).
| PLWHA | General population | P a | PLWHA family | p b | |
|---|---|---|---|---|---|
| Case no. | 200 | 213 | 50 | ||
| Physical health | 13.6 ± 2.35 (6–19) | 15.4 ± 1.81 | <0.001 | 13.2 ± 2.38 | >0.05 |
| Psychological health | 12.3 ± 2.63 (5–19) | 13.7 ± 2.07 | <0.001 | 11.6 ± 2.53 | >0.05 |
| Social relationships | 12.9 ± 2.23 (4–19) | 14.0 ± 2.10 | <0.001 | 12.2 ± 1.96 | 0.033 |
| Environmental | 13.4 ± 2.24 (8–20) | 13.1 ± 2.18 | >0.05 | 11.8 ± 2.21 | <0.001 |
Relationships among demographics, health factors, stress, needs, and QoL
The T test statistics were used to examine the associations of demographic information on stress, needs, and QoL (Table 4). Age, sex, religion, and family structure were not associated with stress, needs, and QoL. PLWHA with a college degree (BS) or higher scored higher in three QoL domains: physical health (p = 0.034), social relationships (p = 0.043), and environment (p < 0.001). The physical QoL of PLWHA was negatively associated with living with family and disclosure of HIV/AIDS diagnosis to family. Compared with those with stable employment, PLWHA who experienced employment loss or change owing to health condition significantly scored higher in stress level, but lower in all four domains of QoL.
We also measured health‐related factors (i.e., CD4 and opportunistic infection) to examine its contribution to needs, stress, and QoL of PLWHA. PLWHA who have been hospitalized reported an inferior physical QoL. PLWHA who perceived a worse health condition scored significantly higher in stress, but lower in QoL for all domains.
Regression
Multiple hierarchical regression analyses were used to examine the impacts of demographics, health factors, needs on stress and QoL, as well as stress on QoL in three models (Table 5). For parsimony, the independent variables in each model were selected based on the tests of means and correlations. Stress was the most significant predictor (β = −0.25 to −0.54, p < 0.001) for QoL in four domains. The QoL of PLWHA can be explained by demographics, self‐perception of health, needs, and stress for 25.3–40.7% of variances.
Table 5.
Effects of demographics and selected variables on stress, needs, and quality of life.
| Predictors | Quality of life | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Stress | Physical health | Psychological health | Social relationships | Environmental | |||||||||||
| Model 1 | Model 2 | Model 3 | Model 1 | Model 2 | Model 3 | Model 1 | Model 2 | Model 3 | Model 1 | Model 2 | Model 3 | Model 1 | Model 2 | Model 3 | |
| Demographics | |||||||||||||||
| Education BS higher/lower | −0.07 | −0.08 | −0.09 | 0.10 | 0.09 | 0.06 | 0.12 | 0.13 | 0.08 | 0.11 | 0.12 | 0.08 | 0.27** | 0.29** | 0.27** |
| Live with family yes/no | 0.07 | 0.07 | 0.03 | −0.16* | −0.15* | −0.12* | 0.03 | 0.04 | 0.07 | 0.06 | 0.07 | 0.09 | 0.02 | 0.02 | 0.04 |
| Family knows patient has AIDS | 0.04 | 0.03 | 0.03 | −0.14* | −0.08 | −0.07 | −0.00 | 0.02 | 0.03 | −0.09 | −0.08 | −0.07 | −0.01 | −0.01 | 0.00 |
| Job loss due to health | 0.18* | 0.11 | 0.11 | −0.20** | −0.08 | −0.04 | −0.18* | −0.10 | −0.04 | −0.17* | −0.09 | −0.05 | −0.19** | −0.11 | −0.08 |
| Disease‐related | |||||||||||||||
| Hospitalization due to AIDS | −0.05 | 0.00 | −0.11 | −0.14* | 0.05 | 0.03 | 0.05 | 0.04 | 0.09 | 0.07 | |||||
| Current health: bad | 0.12 | 0.08 | −0.27** | −0.22** | −0.13 | −0.08 | −0.10 | −0.05 | −0.18* | −0.14 | |||||
| Deteriorating health | 0.16* | 0.16* | −0.25** | −0.20** | −0.20* | −0.11 | −0.19* | −0.13 | −0.16* | −0.12 | |||||
| Mental health | |||||||||||||||
| Stress | — | −0.35** | −0.54** | −0.42** | −0.25** | ||||||||||
| Needs | 0.38** | −0.04 | 0.09 | 0.10 | −0.07 | ||||||||||
| ΔR2 | 5.2% | 14.1% | 20.1% | 12.3% | 10.2% | 23.3% | 5.6% | 13.8% | 7.3% | 7.6% | |||||
| R2 | 4.7% | 9.9% | 24.0% | 9.1% | 28.5% | 40.7% | 5.3% | 12.3% | 35.7% | 6.0% | 11.6% | 25.3% | 12.4% | 19.7% | 27.4% |
*p < 0.05; **p < 0.01. Model 1 predictors: education BS or higher; live with family; family knows patient has AIDS; and job loss due to health. Model 2 predictors: education BS or higher; live with family; family knows patient has AIDS; job loss due to health; hospitalization due to AIDS; current health poor; and deteriorating health. Model 3 predictors: education BS or higher; live with family; family knows patient has AIDS; job loss due to health; hospitalization due to AIDS; current health bad; and deteriorating health, stress, needs. BS = Bachelor of Science.
Discussion
The results of our study indicate that PLWHA generally demonstrated poor QoL, and their stress was the most significant single factor for this. The stress level of PLWHA has a significant contribution to QoL. For PLWHA, stress was correlated with QoL in many countries [[19], [20], [21]]. Most of the stressful events of PLWHA were financial problems and the death of a friend or relative [21]. Healthcare providers in hospitals and in the community should pay more attention when stressful events occurred to PLWHA. We found that needs was not significantly associated with QoL of PLWHA, although it was significantly related to stress. Furthermore, recognizing the PLWHA's perception of health status is important that significantly correlated with their QoL.
The Cronbach α values on the four domains of QoL were >0.7, which indicates a good intercorrelation among the measured items. Cronbach α values > 0.9 revealed that the internal consistency of the items in the stress scales, needs scales, and QoL domains are even better.
Unlike findings in several studies [[13], [17], [22]], our study found that PLWHA had poor physical QoL if they had a history of living with family, being hospitalized for AIDS related events or disclosure. It suggested the role of family as the caregivers when PLWHA were physically sick. Approximately 59% of PLWHA in this study lived with their families. Our results revealed that family is the chief caregiver of PLWHA, as is the situation in Malaysia [22]. Of PLWHA in this study, 52% disclosed their AIDS status to their family, which is less than the rate reported in a Malaysian study [22]. It indicated the PLWHA in Taiwan were not used to disclosing their AIDS status to their family.
Despite many studies finding that individuals with CD4+ count <200 × 106/L had poor QoL [[4], [22]], this study was consistent with Tiwari et al. [3] in that no association existed between CD4+ counts and QoL. The increased CD4+ counts helps to reduce HIV‐related physical symptoms but not the symptom of depression. The effect of self‐perception and psychological distress on individual QoL cannot be overlooked.
Almost one in five PLWHA in our study had lost or changed their employment due to AIDS‐related problems. Consistent with a Canadian study [7], the result of our study demonstrated employment was strongly associated with the stress level and QoL in all four domains. Unemployment or financial instability creates anxiety or insecurity for PLWHA, especially for the young or middle‐aged adults who were expected to be the most productive and contributive age group to family economics. Lost or changed employment status owing to health deterioration or discrimination creates a vicious circle to PLWHA health and QoL.
Similar to the previous studies [[12], [13], [14]], participants with higher education levels (BS or higher) reported better QoL in physical, social, and environmental domains. The contribution of education is particularly prominent in the environmental domain. Lower education level may often be associated with a lower economic status; PLWHA with higher education might have better income and live in better conditions.
More than one half of the participants in the study felt that their health condition was worse than they were before. This result reflects that the needs of PLWHA mainly focused on health maintenance and illness care. The desire of PLWHA to self care for physical needs was very strong. Consistent with previous literature [[8], [9], [10], [22], [23]], the results of this study also indicated that PLWHA were most stressed about disclosure, exposure, discrimination, disease contagion, and unpredictable health condition. Strategies concerning disclosure, HIV prevention, and health maintenance are critical for PLWHA to reduce stress, meet needs, and improve QoL. Although most preferred face‐to‐face consultation, about 25% of participants in this study favored the Internet as a source to obtain information and knowledge about AIDS care. Health informatics in AIDS prevention and care should be further developed for its popularity and privacy. Those PLWHA who preferred the Internet as the main method to access their required information may benefit from better on‐line informatics, while the case managers and healthcare workers may provide adequate information to meet the needs of PLWHA.
The results of this study were in agreement with a study in China [4]: the QoL of PLWHA was inferior to that of the general population. However, PLWHA reported better QoL when compared with that of family members of PLWHA in Taiwan in our previous study [18], especially in social and environmental domains in Taiwan. The possible reasons may be that medical accessibility in Taiwan provides care and support for PLWHA, whereas family members had fewer sources from physicians and case managers. There was no statistical difference in physical and psychological domains.
This study is limited because the majority of the participants in this study were male. We cannot explore the sex difference in stress, needs, and QoL in the study. Women may respond very differently in relation to their roles in the family and society. The QoL of female PLWHA and associated factors deserve further exploration. In addition, a study design on the dyad of both PLWHA and caregivers can help observe the dynamic relationships of stress and QoL between patients and caregivers across the different stages of illness. Most of the PLWHA in the report were men who have sex with another men (MSM). The QoL scores of MSM were found to be lower than those of general residents [24]. We did not investigate the impact of MSM on QoL in the study. A further study on the difference of QoL between MSM with HIV/AIDS and MSM without HIV/AIDS is warranted.
In conclusion, this study indicates that PLWHA in Taiwan had poor QoL and felt very stressful about revealing diagnosis, unpredictable health condition, and HIV transmission. There is a need to recognize the stress and needs that PLWHA experienced and to develop intervention programs targeting strategies on disclosure, HIV prevention, and health maintenance to enhance QoL for PLWHA.
Acknowledgments
This research was supported by a grant from the Kaohsiung Medical University Hospital, grant number KMUH98‐8G15. We sincerely thank the study participants for their contribution.
Supporting information
Supplementary data
Supplementary data
Supplementary data related to this article can be found at https://doi.org/10.1016/j.kjms.2015.07.003
Conflicts of interest: All authors declare no conflicts of interest.
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