|Year : 2012 | Volume
| Issue : 2 | Page : 116-121
Impact of HIV/AIDS on quality of life of people living with HIV/AIDS in Chitradurga district, Karnataka
KH Rajeev1, BY Yuvaraj2, MR Nagendra Gowda1, SM Ravikumar3
1 Associate Professor, Community Medicine, Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India
2 Associate Professor, Community Medicine, SS Institute of Medical Sciences, Davangere, Karnataka, India
3 Medico Social Worker, Department of Community Medicine, Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India
|Date of Web Publication||21-Aug-2012|
K H Rajeev
Associate Professor in Community Medicine, Basaveshwara Medical College and Hospital, Chitradurga - 577502, Karnataka
| Abstract|| |
Background: HIV/AIDS is fatal illness which leaves the victim vulnerable. Quality of life in individuals living with HIV/AIDS is becoming crucial for measuring commonly used endpoints. The study of psychosocial factors also influences the health outcome of People Living with HIV/AIDS. Aim: To assess the Quality of life of PLHA in relation to various socio-demographic and clinical correlates. Setting and Design: A community care center in Chitradurga district and it is a Cross sectional study. Methods and Materials: About 395 PLHAs registered in the centre constituted the sample. WHOQOL - 120 instrument was used for assessing quality of life. The socio demographic factors were also obtained in pre designed proforma. Statistical Analysis Used: Proportions, Mean, Std deviation, One way Analysis of Variance (ANOVA). Results and Conclusion: The Quality of Life scores for all domains were intermediate for the PLHAs between (10 - 14). The mean scores were highest for psychological domain. There was a significant difference in QOL of PLHA who were on ART and Not on ART in some domains. PLHAs who were literates, married, Single, employed, income more than 1500 not on ART, CD4 count more than 200, earlier stages of HIV, living with spouse and students had high mean scores. Mean difference of QOL scores with duration of ART intake were statistically significant in psychological and Spirituality domains. QOL was found to be determined by education, income, occupation, ART status, duration of taking ART and clinical categories of the disease.
Keywords: Quality of life, Human immunodeficiency virus/acquired immune deficiency syndrome, Patient adherence
|How to cite this article:|
Rajeev K H, Yuvaraj B Y, Nagendra Gowda M R, Ravikumar S M. Impact of HIV/AIDS on quality of life of people living with HIV/AIDS in Chitradurga district, Karnataka. Indian J Public Health 2012;56:116-21
|How to cite this URL:|
Rajeev K H, Yuvaraj B Y, Nagendra Gowda M R, Ravikumar S M. Impact of HIV/AIDS on quality of life of people living with HIV/AIDS in Chitradurga district, Karnataka. Indian J Public Health [serial online] 2012 [cited 2014 Dec 22];56:116-21. Available from: http://www.ijph.in/text.asp?2012/56/2/116/99901
| Introduction|| |
Human immunodeficiency virus (HIV) / acquired immune deficiency syndrome (AIDS) is a fatal illness which leaves the victim vulnerable to lot of life threatening opportunistic infections, neurological disorder, or unusual malignancies.  Living with HIV/AIDS not only hampers physical health but also mental and social well being. It is not simply a virus that causes disease, but also a social and historical event that impacts how others react toward people living with HIV/AIDS (PLHA).  Unless a cure is found or life prolonging therapy can be made widely available, majority of PLHAs will suffer with the disease, with serious impact on quality of life. 
Quality of life (QOL) is a complex and multidimensional concept that is difficult to define and measure.  World Health Organization defines the quality of life as individual's perceptions of their position in the life in the context of culture and value systems in which they live and in relation to their goals, standards, expectations, and concerns. Assessment of QOL in individuals living with HIV/AIDS is becoming crucial to research and evidence based practice in this area. QOL is currently considered essential for clinical trials in HIV infection, as commonly used end-points (CD4 level, viral load, and opportunistic diseases) are inadequate to catch the complexity of treatment outcomes. Additionally the study of psychosocial factors those are likely to influence health outcomes in HIV - infected individuals can increase the understanding of this disease and allow to design more efficient interventions. With this idea, this study was taken up in this part of the country. This study aims to find out the quality of life scores in patients living with HIV/AIDS pertaining to their Socio - demographic variables.
| Materials and Methods|| |
A community based, cross sectional study was conducted by visiting the homes of patients attending the Community Care Center (CCC) of Chitradurga city. The objective was the quality of life of PLHA. All the PLHAs who were enrolled in the CCC were contacted for a written consent to visit in their house to assess the quality of life. The study was conducted from August 2010 to December, 2010. Ethical clearance was obtained from Institutional Ethical Committee of the college.
Quality of life was evaluated using World Health Organization (WHOQOL) 120 instrument. WHOQOL - HIV 120 instrument consists of 120 questions related to various aspects of quality of life. Each item uses likert type of five point scale where 1 indicates low, negative perceptions and 5 indicates high, positive perceptions. The items are distributed over six domains. These six domain scores denote an individual's perception of quality of life in physical, psychological, level of independence, social relationships, environment and spirituality domains. The domain and facet scores are scaled in a positive direction where higher score denote higher quality of life. The negative facets like pain and discomfort, negative feelings, dependence on medication, death and dying were recorded so that high scores reflect better quality of life.
A questionnaire which was prepared on the basis of WHO-QOL questionnaire according to local language and settings was administered in the home of PLHAs. A total of 700 PLHAs were registered at the Community Care centre as of August 2010, about 100 registrants were died of HIV and 400 PLHAs aged between 15 and 72 years gave the consent to visit their house. The data were collected by trained interns and staff of the Department. The particulars of 5 PLHAs were ignored due to incomplete data. The data thus obtained were compiled and analyzed.
Statistical analysis was performed using statistical analysis software SPSS version 13.0. The descriptive variables such as mean, standard deviation were used. Z test and One-way Analysis of Variance (ANOVA) was performed for finding out significant difference between the domain scores and other variables.
| Results|| |
Characteristics of the Study Population
The final sample for analysis constituted 395 PLHAs. Of them 231 (58.5%) PLHAs were on ART and 164 (41.5) were not on ART [Table 1].
The mean age group of PLHAs on ART was 38.00 ± 9.73 years and not on ART group was 34.9 ± 10.23 years. Total 54.4% of the subjects were males and 45.6% were females. The mean income was about ` 2750 in ART and ` 3080 in not on ART group. About 37% of patients on ART and 38% of PLHAs not on ART were illiterates. Majority of the PLHAs, who were able to read and write, educated up to High school and above. About 23% of the patients in both the groups were widowed due to death of the spouse. Surprisingly, 11.3% of the ART group and 7.3% of the PLHAs who were not on ART were not married. Most of the PLHAs were non agricultural laborers, belonged to stage I of WHO clinical staging, family support was present in more than 80% of PLHAs, the main mode of transmission was through heterosexual route but majority of the PLHAs did not knew their route of transmission; about 60.2% of the PLHAs on ART had CD4 count of less than 200. Majority of the non responders (50.3%) were males, the mean age was 37.64 years, about 55% had the ability to read and write, 22% were widowed, 3.7% were separated, and 8.3% were unmarried, about 34.7 were non agricultural laborers and 65.3% were on ART.
[Table 2] shows the mean scores in the six domains of quality of life. QOL scores were high for psychological domain followed by spirituality/religion/personal beliefs, social relationship domain in descending order. There was statistically significant difference in the quality of life scores of ART and not on ART groups of first, second, and sixth domains. Inter domain correlations were found positively significant, between all pairs of the six domains using two-tailed test at P < 0.01 (Pearson coefficient varied between + 0.03 to + 0.2 between domain pairs).
[Table 3] shows the mean domain scores and standard deviation pertaining to various Socio-demographic variables. Males had high mean QOL scores in I, II, V, and VI domains. PLHAs who were literates, married, Single, employed, income more than `1500 not on ART, CD4 count more than 200, those who were living with the spouse and students had high mean scores of QOL. While females, illiterates, divorced, or separated from their spouse, unemployed, with income less than ` 1500 who were on ART, CD4 count less than 200 had low mean QOL scores.
|Table 3: Quality of life scores of various domains depending upon various demographic variables|
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[Table 4] shows the mean and std deviation of quality of life scores depending upon the WHO clinical stages of HIV. PLHAs with earlier stages of HIV had higher mean scores of quality of life compared to later stages (III and IV) of HIV in physical and psychological domains. But there was not much difference in level of independence, social relationship, environment, and spirituality/religion/personal beliefs domains.
|Table 4: Mean and Std deviation of quality of life scores on the basis of Stage of the disease|
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On analyzing the mean and standard deviation of quality of life scores of PLHAs with duration of ART intake, statistically significant difference was found in psychological and spirituality/religion/personal beliefs domains [Table 5].
|Table 5: Mean and standard deviation of quality of life scores depending upon Increase in duration of ART|
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| Discussion|| |
This study was aimed at assessing the quality of life of people living with HIV/AIDS. Physical domain (Domain I) assesses the impact of disease on physical health as facets such as pain and discomfort of taking medications, enthusiasm of a person to perform necessary tasks of daily living. Inadequate sleep and rest due to the disease may also hamper the quality of life of the PLHAs.
Patients thought about own body image appearance will be assessed by psychological domain. It is affected by education, income, occupation, ART treatment, and WHO clinical categories. High mean scores of quality of life in people who studied high school and above often determine the psychological domain. People with high income also have high coping ability with the disease. Low psychological scores are often reflection of increased morbidity and negative attitude toward life.
Domain III (level of independence) mainly examines the ability of PLHAs to move freely from one place to another place in home or outside. Ability to perform daily activities, dependence on medication or treatment, working capacity are examined under this domain.
Personal relationships, social support from family, sexual activity which may be hampered as an impact of disease are assessed under Social domain.
Environmental domain reflects effect of disease physical safety and security, home environment, financial disturbances, availability and quality of health and social care, opportunities for acquiring new information and skill, participation in recreation activities, physical environment, and availability transport.
The spirituality/religion/personal belief domain examines how disease can affect the quality of life of PLHAs. 
The scores of all domains were intermediate (10 to 14.9) for the PLHAs. But in a study at Sao Paulo, Brazil  the quality of life scores using WHOQOL Bref questionnaire were close to high level for physical and psychological domains and intermediate level for social relationships and environmental level. The difference in scores may be due to large number of PLHAs were not on ART or just started ART.
QOL scores were highest for psychological domain in this study followed by spirituality, social relationship, and level of independence domains in descending order. The score was low for environmental domain. In a study by Wig et al.  the QOL scores were highest for social domain assessing personal relationships, social support, and sexual activity.
There was significant difference in quality of life scores of PLHA who were on ART and not on ART in physical, psychological and spirituality/religion/personal belief domains of WHO quality of life scores. No studies are available for comparison in this aspect.
PLHAs who were literates, married, Single, employed, income more than ` 1500 not on ART, CD4 count more than 200, those who were living with the spouse and students had high mean scores of QOL. PLHAs with earlier stages of HIV had higher mean scores of quality of life compared to later stages (III and IV) of HIV in physical and psychological domains. But there was not much difference in scores of level of independence, social relationship, environment and spirituality/religion/personal beliefs domains.
On analyzing the mean and standard deviation of quality of life scores of PLHAs with duration of ART intake, statistically significant difference was found in psychological and spirituality/Religion/personal beliefs domains. Mannheimer  has shown that the increase in duration of ART will increase the quality of life as early as 1 month after initiation of ART. Study also showed that even high adherence level to ART will increase the quality of life.
| Conclusion|| |
Since many factors influence the quality of life, various facets of different domains have been examined. The overall quality of life of PLHAs was intermediate level as evident by the study. It was found to be determined by education, income, occupation, ART status, duration of taking ART, and clinical categories of the disease. Even though PLHAs had better scores in physical and psychological domains but face difficulties in their social relationships. However, QOL life is not constant throughout the life of PLHAs and cannot be established by a cross-sectional study. The effect of disease on QOL, ART treatment, efforts of income generating, and welfare programms by the government and non governmental organizations can be revealed by the longitudinal studies.
Limitations of the Study
This study is not without limitations. Recall bias cannot be ruled out. Most of the responders either died or did not give their consent to participate were another drawback. The children with HIV/AIDS could not turn out to the Community Care Center preclude the generalization of results. The cross-sectional study could not make out the change in quality of life of PLHA.
| References|| |
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|4.||Janca A. Images in psychiatry. World health organization. Division of mental health and prevention of substance abuse. Am J Psychiatry 1998;155:277. |
|5.||Santos EC, França I Jr, Lopes F. Quality of life of people living with HIV/AIDS in Sao Paulo, Brazil. Rev Saude Publica 2007;41 Suppl 2:S64-71. |
|6.||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. |
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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