What influences quality of life in older people living with HIV?

Abstract

BackgroundPeople with HIV with access to treatment are growing older and living healthier lives than in the past, and while health improvements and increased survival rates are welcome, the psychological and social consequences and quality of life of ageing are complex for this group. Understanding how ageing, HIV and quality of life intersect is key to developing effective interventions to improve QoL.MethodsOne hundred people with HIV over the age of 50 (range 50–87, mean 58), were recruited through HIV community organizations, and clinics, and included men who have sex with men (MSM), and Black African and White heterosexual men and women. The WHOQOL-HIV BREF was used, as well as the Every Day Memory Questionnaire, and additional questions on anxiety and depression to supplement the WHOQOL.ResultsWhile most rated their quality of life (QoL) positively, bivariate analysis showed that better QoL (total score and most domains) was strongly associated with being a man; in a relationship; in paid employment; having higher level of income; not on benefits, and to a lesser degree with being MSM, having higher level of education, and diagnosed after the age of 40. Multivariate analysis showed that not being on benefits was the variable most consistently associated with better quality of life, as was being partnered. Concerns about everyday memory difficulties, and anxiety and depression scores were strong predictors of poorer quality of life.ConclusionWhile the cross-sectional nature of the investigation could not establish that the associations were causal, the findings indicate that concerns about memory difficulties, anxiety and depression, as well as gender, ethnicity, financial factors, and relationship status, are important contributors to QoL in this group. These findings point towards the need for further research to clarify the mechanisms through which the factors identified here affect QoL, and to identify possible interventions to improve the QoL of older people living with HIV.

Stigma, isolation and depression among older adults living with HIV in rural areas

“…For example, HIV stigma made it difficult to establish romantic or sexual relationships, which was especially evident among gay men, many of whom also had to contend with homonegativity. This is important, as previous research has demonstrated that being in a relationship can improve the quality of life among older persons with HIV (Catalan et al ., 2017) and successful ageing with HIV often includes deliberately creating social networks that promote resilience and positivity (Emlet, 2017). Yet, for many in this study, their rural environment and social isolation was such that they had few options for social support, much less romantic or sexual relationships.…”

“…Rooted in intersectionality theory, intersectional stigma can help explain how persons simultaneously experience multiple stigmas and how such stigmas affect social, mental and physical wellbeing (Logie et al ., 2011). Intersectional stigma, and its manifestations and consequences, can contribute to poor quality of life in older people living with HIV (Catalan et al ., 2017). Older adults living with HIV are often subject to the intersecting stigmas of ageism and HIV stigma, and some may also have to contend with racism and/or homonegativity, the combination of which may multiply the negative effects on their mental health and access to social support (Emlet et al ., 2013).…”

Association between social capital and mental health among older people living with HIV: the Sichuan Older HIV-Infected Cohort Study (SOHICS)

“…In China, the prevalence of depressive symptom was 74.2% among older PLWH [8], the rate is higher than that of their younger counterparts [8,[11][12][13], due to age-related reduction in immune responses, impaired physical function, reduced social support, or difficulties in coping with HIV-related stress [8,14]. Therefore, more attention should be given to this older PLWH [15][16][17].…”

‘The own’ and ‘the wise’ as social support for older people living with HIV in the United Kingdom

“…Four participants did not fall neatly within our three core participant groups: one White bisexual woman and one Black African women of unknown sexual orientation, whose interviews and survey data we analysed, and one heterosexual man and one heterosexual woman of Black Caribbean heritage, whom we excluded from qualitative analysis while retaining their survey data, which are not shown here (for survey data analysis and findings, see Rosenfeld et al , 2015; Catalan et al ., 2017). We stopped recruiting after preliminary analysis achieved theoretical saturation (Charmaz, 2014).…”

“…As people living with HIV (PLWH) age following the introduction of effective antiretroviral therapy in 1996 (Sabin, 2013), which changed HIV from a typically fatal condition to a potentially long-term manageable one, research into the social dimensions of ageing with HIV is growing (Emlet, 2006 a , 2008; Wallach and Brotman, 2013; Nevedal and Sankar, 2015; Hutton, 2016; Furlotte and Schwartz, 2017; Catalan et al ., 2017; Wallace and Brotman, 2017). Much of this research documents the distinctive challenges that ageing introduces to the experience of living with HIV (within the HIV context, the term ‘older’ refers to those aged 50 and above; see e.g.…”