Perceived stigma, medical social support and quality of life among people living with HIV/AIDS in Hunan, China

Abstract

Purpose

The present study aimed at examining the relationships among perceived stigma, social support, and quality of life (QOL) in people living with HIV (PLWH).

Methods

We recruited 190 participants meeting the inclusion criteria from two HIV clinics in Hunan, China. HIV-related Stigma Scale, the Chinese Version of the Medical Outcomes Study — Social Support Survey (MOS-SSS-C), and the Medical Outcomes Study-HIV (MOS-HIV) were used to measure the perceived stigma, social support and QOL in PLWH.

Results

The mean scores of the perceived stigma, social support, and QOL were 104.32, 53.63, and 61.97 respectively, which were in moderate range. Stepwise multivariate regression analysis showed (R² = .49, p < .01) a low score of internalized stigma and family stigma, a high score of tangible support for non-drug use and antiretroviral treatment, and high CD4 count predicted better QOL.

Conclusion

Perceived stigma and social support are correlated with the QOL in PLWH. Interventions designed to decrease perceived stigma and strengthen social support from family are necessary to improve the QOL in PLWH.

Introduction

AIDS is the leading cause of death in China when compared with other infectious diseases and has drawn much attention. The China AIDS Response Progress Report of 2012 estimated 780,000 people living with HIV/AIDS (PLWH) in China at the end of 2011, with a prevalence rate of 0.058% in the general population (Ministry of Health of China, 2012). Highly active antiretroviral therapy (HAART) is the standard treatment for HIV infection in the world and has decreased mortality and morbidity among PLWH (Kushnir & Lewis, 2011). By the end of 2011, almost 155,000 PLWH received HAART in China, with adults increasing from 67.2% in 2011 to 76.1% (Ministry of Health of China, 2012). Currently, counseling and monitoring services sponsored by the government are being expanded in most provinces in China to control the spread of HIV/AIDS. HIV infection has become a chronic and manageable disease as diabetes and high blood pressure (Oguntibeju, 2012).

In China, several studies reported that the QOL of PLWH worsened when people’s HIV status was notified, especially for those infected through sexual contact (Sun et al., 2012, Sun et al., 2013). Meng et al. (2008) reported poor QOL of PLWH measured with short form SF-36. Another study showed that the mean score of overall QOL in Hubei was 25.8 by WHOQOL-BREF instrument (Chinese version) (Mkangara et al., 2009). HIV positive individuals reported poor QOL in groups such as the widowed or separated women, people with lower levels of education and the needy. A report found out that in Thailand PLWH had a moderate QOL (Munsawaengsub, Khair, & Nanthamongkolchai, 2012). But in Nepal, the QOL of PLWH was low with a mean score of 4 measured by the World Health Organization Quality of Life Questionnaire, and psychological domain was also the lowest (Giri et al., 2013).

In the era of HAART, a majority of patients are now on the life prolonging treatment globally. HAART has improved the QOL of PLWH by reducing the morbidity and mortality that were previously associated with AIDS, but the adverse reactions such as fatigue, anemia and digestive tract disorders are to blame for the low QOL of some patients (Adane et al., 2012, Mandorfer et al., 2013). In China, many patients have been diagnosed at advanced stages of the disease with severe symptoms, lower CD4 count and higher viral load, which mean that they have to deal with problems such as chronic clinical symptoms, heavy economic burden for health care, and loss of labor due to illness, and eventually poor QOL (He et al., 2012).

HIV-related discrimination and stigma impact negatively on the QOL of PLWH (Fuster-Ruizdeapodaca et al., 2014, Herrmann et al., 2013). HIV/AIDS is highly stigmatized in China with PLWH trying to cope with daily discrimination, in despite of the introduction of “Four Free, One Care” policy and increased knowledge and understanding of HIV/AIDS. For the public, AIDS is associated with “horror”, “drug abuse”, “metamorphosis”, and “sexual promiscuity (Goffman, 1963). “Sex” has always been an obscure topic in China and the public considered PLWH as sexual perverts who suffer for sexual immorality and deserve no mercy. Public discrimination makes them feel guilty, afraid of normal interaction with friends, lose social support, and denied job opportunities. Moreover, perceived stigma and discrimination may prevent PLWH from disclosing their status and treatment, causing non-adherent therapy, low self-esteem and poor QOL (Charles et al., 2012, Li et al., 2011). PLWH are beset with various psychological problems, such as depression (Charles et al., 2012), anger (Archibald, 2010), despair and hatred, which all negatively affect their QOL directly or indirectly.

Social support has a significant effect on the QOL of PLWH. Previous studies reported that social support was correlated with the QOL (Bajunirwe et al., 2009, Gielen et al., 2001, Yadav, 2010). People with good social support reported better mental health and QOL. In Colombia, satisfaction with family support was significantly associated with patients’ QOL (Cardona-Arias, Pelaez-Vanegas, Lopez-Saldarriaga, Duque-Molina, & Leal-Alvarez, 2011). Social support provides psychological boost for PLWH which in turn ensures a good mental state, a necessity for good health.

Previous studies have reported the relationships between stigma, social support, and QOL. But in China, researches on the QOL of PLWH mainly focus on exploring the relationship between different factors and finding the mediation effect (Li et al., 2011, Rao et al., 2012), while studies on relationships between the physical index, medical social support, stigma and QOL are rare. To recommend new interventions to improve QOL and help PLWH manage the chronic disease, we applied a cultural grounded stigma scale and certain physical indexes to explore the relationships among these factors.