Association of syndemic conditions and quality of life among people living with HIV/AIDS

ABSTRACT

The syndemics theory seeks to understand the effect of multiple synergic problems in promoting poor health outcomes. To disentangle which and how syndemic conditions affect the quality of life (QoL) may be important to improve well-being of people living with HIV/AIDS (PLWHA). This study evaluates the association between syndemic conditions and QoL among PLWHA. We performed a secondary analysis using data obtained between 2014 and 2017 among PLWHA under care in Rio de Janeiro, Brazil. The outcomes were the six QoL domains (physical, psychological, level of independence, social relationships, environmental, and spirituality) measured through the World Health Organization Quality of Life in HIV infection scale, abbreviated version (WHOQOL-HIV-BREF). The independent variables were demographic and clinical characteristics, syndemic conditions (binge drinking, compulsive sexual behavior, polysubstance use, intimate partner violence, and depression), and syndemics (two or more syndemic conditions simultaneously). Bivariate analysis (t-test and ANOVA) and linear regressions were performed for each quality-of-life domain. The analytical sample comprised 1530 participants, mostly male at birth (64%) and with median age of 43 years. The syndemic conditions most frequently observed were binge drinking (56%), IPV (13%), and depression (9%). Both individual syndemic conditions and syndemics were associated with worse QoL. In the multivariate analysis, positive screening for depression was associated with worse QoL in all domains. Polysubstance users presented worse QoL at social and environmental domains. Intimate partner violence was associated with worse QoL at environment domain while binge drinking was associated with worse scores in the physical domain. The presence of syndemics increased the likelihood of worse scores in the psychological, social, and environment domains. Our study expands the understanding of QoL in PLWHA, as it considers a holistic/integral, multifactorial, and synergistic approach to the determinants of QoL. Seeking strategies that target syndemics may be important to improve patient-centered outcomes in health.

Abbreviations: HIV/AIDS: human immunodeficiency virus/acquired immunodeficiency syndrome

WHO: World Health Organization

QoL: quality of life

HRQoL: health-related quality of life

PLWHA: people living with HIV/AIDS

cART: combined antiretroviral therapy

IPV: intimate partner violence

INI/FIOCRUZ: Evandro Chagas National Institute of Infectious Diseases

Oswaldo Cruz Foundation

SRH: self-rated health

VL: viral load

CD4: CD4 cell count

NIAAA: National Institute on Alcohol Abuse and Alcoholism

CSB

compulsive sexual behavior

WHO-ASSIST: alcohol

smoking and substance involvement screening test developed by the World Health Organization

PHQ-2: Patient Health Questionnaire-2

KEYWORDS:

• Syndemics
• quality of life
• HIV
• AIDS
• mental health
• substance abuse

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Institutional Program for Scientific Initiation Scholarships (Programa Institucional de Bolsas de Iniciação Científica – PIBIC/CNPq). National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq), grant number 310541/2017-4. Carlos Chagas Filho Research Support Foundation of Rio de Janeiro (Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ): E-26/203.154/2017. Programa de Incentivo a Jovens Pesquisadores do INI Evandro Chagas – FIOCRUZ .