AIDS and Behavior

, Volume 21, Issue 6, pp 1580–1587

Psychosocial and Service Use Correlates of Health-Related Quality of Life Among a Vulnerable Population Living with HIV/AIDS

  • Mary M. Mitchell
  • Trang Q. Nguyen
  • Sarina R. Isenberg
  • Allysha C. Maragh-Bass
  • Jeanne Keruly
  • Amy R. Knowlton
Original Paper


Among people living with HIV/AIDS (PLHIV), health-related quality of life (HRQOL) is an important clinical metric of perceived well-being. Baseline data from the BEACON study (N = 383) were used to examine relationships between HRQOL and negative social support, HIV-related stigma, viral suppression, and physical and mental health service use among a vulnerable population of low-income, urban PLHIV who currently or formerly used substances, and were primarily African American. Factor analyses and structural equation modeling indicated that increases in negative social support, stigma, mental health care visits and HIV physician visits were associated with lower HRQOL, while viral suppression was associated with greater HRQOL. The association between negative social support and HRQOL suggests the importance of intervening at the dyad or network levels to shape the type of social support being provided to PLHIV. HIV-related stigma is another negative social factor that is prevalent in this sample and could be addressed by intervention. Results indicate that greater mental and physical health service use can be used to identify individuals with lower HRQOL. Therefore, findings increase an understanding of HRQOL in this understudied population and have implications for designing interventions to improve HRQOL among PLHIV.


Health-related quality of life HIV/AIDS African American or Black Drug use disorder HIV-related stigma Negative social support 


  1. 1.
    Perez IR, Bano JR, Ruz ML, et al. Health-related quality of life of patients with HIV: impact of sociodemographic, clinical and psychosocial factors. Qual Life Res. 2005;14(5):1301–10.CrossRefGoogle Scholar
  2. 2.
    Wu A, Lamping D. Assessment of quality of life in HIV disease. AIDS. 1994;8:S349.Google Scholar
  3. 3.
    Buseh AG, Kelber ST, Stevens PE, Park CG. Relationship of symptoms, perceived health, and stigma with quality of life among urban HIV-infected African American men. Public Health Nurs. 2008;25(5):409–19.CrossRefPubMedGoogle Scholar
  4. 4.
    Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study. Med Care. 1995;33:AS264–79.CrossRefPubMedGoogle Scholar
  5. 5.
    Ware JE Jr, Kosinski M, Keller SD. A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Wu AW, Hays RD, Kelly S, Malitz F, Bozzette SA. Applications of the medical outcomes study health-related quality of life measures in HIV/AIDS. Qual Life Res. 1997;6(6):531–54.CrossRefPubMedGoogle Scholar
  7. 7.
    Peter E, Kamath R, Andrews T, Hegde BM. Psychosocial determinants of health-related quality of life of people living with HIV/AIDS on antiretroviral therapy at Udupi district, Southern India. Int J Prev Med. 2014;5(2):203–9.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Bekele T, Rourke SB, Tucker R, et al. Direct and indirect effects of perceived social support on health-related quality of life in persons living with HIV/AIDS. AIDS Care. 2013;25(3):337–46.PubMedGoogle Scholar
  9. 9.
    Lincoln KD. Social support, negative social interactions, and psychological well-being. Soc Serv Rev. 2000;74(2):231–52.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kiecolt-Glaser JK, Glaser R, Cacioppo JT, Malarkey WB. Marital stress: immunologic, neuroendocrine, and autonomic correlatesa. Ann N Y Acad Sci. 1998;840(1):656–63.CrossRefPubMedGoogle Scholar
  11. 11.
    Newsom JT, Nishishiba M, Morgan DL, Rook KS. The relative importance of three domains of positive and negative social exchanges: a longitudinal model with comparable measures. Psychol Aging. 2003;18(4):746.CrossRefPubMedGoogle Scholar
  12. 12.
    Rook KS, Pietromonaco P. Close relationships: ties that heal or ties that bind. Adv Pers Relatsh. 1987;1:1–35.Google Scholar
  13. 13.
    Oetzel J, Wilcox B, Archiopoli A, et al. Social support and social undermining as explanatory factors for health-related quality of life in people living with HIV/AIDS. J Health Commun. 2014;19(6):660–75.CrossRefPubMedGoogle Scholar
  14. 14.
    Herek GM. Thinking about AIDS and stigma: a psychologist’s perspective. J L Med Ethics. 2002;30:594.CrossRefGoogle Scholar
  15. 15.
    Herrmann S, McKinnon E, Hyland NB, et al. HIV-related stigma and physical symptoms have a persistent influence on health-related quality of life in Australians with HIV infection. Health Qual Life Outcomes. 2013;11(1):1.CrossRefGoogle Scholar
  16. 16.
    Holzemer WL, et al. Exploring HIV stigma and quality of life for persons living with HIV infection. J Assoc Nurs AIDS Care. 2009;20(3):161–8.CrossRefGoogle Scholar
  17. 17.
    Li X, Huang L, Wang H, Fennie KP, He G, Williams AB. Stigma mediates the relationship between self-efficacy, medication adherence, and quality of life among people living with HIV/AIDS in China. AIDS Patient Care STDs. 2011;25(11):665–71.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Bucciardini R, Pugliese K, Weimer L, et al. Relationship between health-related quality of life measures and high HIV viral load in HIV-infected triple-class-experienced patients. HIV Clin Trials. 2014;15(4):176–83.CrossRefPubMedGoogle Scholar
  19. 19.
    Degroote S, Vogelaers D, Vandijck DM. What determines health-related quality of life among people living with HIV: an updated review of the literature. Arch Public Health. 2014;72(1):1–10.CrossRefGoogle Scholar
  20. 20.
    Hays RD, et al. Health-related quality of life in patients with human immunodeficiency virus infection in the United States: results from the HIV Cost and services utilization study. Am J Med. 2000;108(9):714–22.CrossRefPubMedGoogle Scholar
  21. 21.
    Ware JE. How to score and interpret single-item health status measures: a manual for users of the of the SF-8 health survey: (with a supplement on the SF-6 health survey). Lincoln: Quality Metric Incorporated; 2001.Google Scholar
  22. 22.
    Portenoy RK, Thaler HT, Kornblith AB, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994;30(9):1326–36.CrossRefGoogle Scholar
  23. 23.
    Mitchell MM, Maragh-Bass AC, Nguyen TQ, Isenberg S, Knowlton AR. The role of chronic pain and current substance use in predicting negative social support among disadvantaged persons living with HIV/AIDS. AIDS Care. 2016;28:1–7.Google Scholar
  24. 24.
    Knowlton AR, Nguyen TQ, Robinson AC, Harrell PT, Mitchell MM. Pain symptoms associated with opioid use among vulnerable persons with HIV: an exploratory study with implications for palliative care and opioid abuse prevention. J Palliat Care. 2015;31(4):328–35.CrossRefGoogle Scholar
  25. 25.
    Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Measure. 1977;1(3):385–401.CrossRefGoogle Scholar
  26. 26.
    Knowlton AR, Latkin CA, Chung SE, Hoover DR, Ensminger M, Celentano DD. HIV and depressive symptoms among low-income illicit drug users. AIDS Behav. 2000;4(4):353–60.CrossRefGoogle Scholar
  27. 27.
    Purcell DW, Metsch LR, Latka M, et al. Interventions for seropositive injectors—research and evaluation: an integrated behavioral intervention with HIV-positive injection drug users to address medical care, adherence, and risk reduction. J AIDS. 2004;37:S110–8.Google Scholar
  28. 28.
    Arribas JR, Pulido F, Delgado R, et al. Lopinavir/ritonavir as single-drug therapy for maintenance of HIV-1 viral suppression: 48-week results of a randomized, controlled, open-label, proof-of-concept pilot clinical trial (OK Study). J AIDS. 2005;40(3):280–7.Google Scholar
  29. 29.
    IBM Corporation. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corporation 1999.Google Scholar
  30. 30.
    Muthén L, Muthén B. Mplus user’s guide. 7th ed. Los Angeles: Muthén & Muthén; 1998–2012.Google Scholar
  31. 31.
    Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6(1):1–55.CrossRefGoogle Scholar
  32. 32.
    Blaney NT, Goodkin K, Morgan RO, et al. A stress-moderator model of distress in early HIV-1 infection: concurrent analysis of life events, hardiness and social support. J Psychosom Res. 1991;35(2):297–305.CrossRefPubMedGoogle Scholar
  33. 33.
    Galvan FH, Davis EM, Banks D, Bing EG. HIV stigma and social support among African Americans. AIDS Patient Care STDS. 2008;22(5):423–36.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Rook KS. Stressful aspects of older adults’ social relationships: current theory and research. Stress and coping in later-life families. 1990. pp. 173–192.Google Scholar
  35. 35.
    MacDonald Geoff, Leary Mark R. Why does social exclusion hurt? The relationship between social and physical pain. Psychol Bull. 2005;131(2):202.CrossRefPubMedGoogle Scholar
  36. 36.
    Mitchell MM, Knowlton AR. Stigma, disclosure, and depression among caregivers of HIV positive individuals. AIDS Patient Care STDs. 2009;23(8):611–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Rook KS. Parallels in the study of social support and social strain. J Soc Clin Psychol. 1990;9(1):118–32.CrossRefGoogle Scholar
  38. 38.
    Walen HR, Lachman ME. Social support and strain from partner, family, and friends: costs and benefits for men and women in adulthood. J Soc Personal Relatsh. 2000;17(1):5–30.CrossRefGoogle Scholar
  39. 39.
    Clayson DJ, Wild DJ, Quarterman P, Duprat-Lomon I, Kubin M, Coons SJ. A comparative review of health-related quality-of-life measures for use in HIV/AIDS clinical trials. Pharmacoeconomics. 2006;24(8):751–65.CrossRefPubMedGoogle Scholar
  40. 40.
    Wu AW, Huang I, Gifford AL, Spritzer KL, Bozzette SA, Hays RD. Creating a crosswalk to estimate AIDS clinical trials group quality of life scores in a nationally representative sample of persons in care for HIV in the United States. HIV Clin Trials. 2005;6(3):147–57.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mary M. Mitchell
    • 1
  • Trang Q. Nguyen
    • 2
  • Sarina R. Isenberg
    • 1
  • Allysha C. Maragh-Bass
    • 1
  • Jeanne Keruly
    • 3
  • Amy R. Knowlton
    • 4
  1. 1.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Division of Infectious DiseasesSchool of MedicineBaltimoreUSA
  4. 4.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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