Perceived HIV stigma and life satisfaction among persons living with HIV infection in five African countries: A longitudinal study

Greeff, Minrie; Uys, Leana R.; Wantland, Dean; Makoae, Lucy; Chirwa, Maureen; Dlamini, Priscilla; Kohi, Thecla W.; Mullan, Joseph; Naidoo, Joanne Rachel; Cuca, Yvette; Holzemer, William L.

doi:10.1016/j.ijnurstu.2009.09.008

« Previous Next »International Journal of Nursing Studies
Volume 47, Issue 4 , Pages 475-486, April 2010

Perceived HIV stigma and life satisfaction among persons living with HIV infection in five African countries: A longitudinal study

Minrie Greeff
- North-West University, Potchefstroom Campus, South Africa
Leana R. Uys
- University of KwaZulu-Natal, South Africa
Dean Wantland
- University of California, San Francisco, United States
Lucy Makoae
- National University of Lesotho, Lesotho
Maureen Chirwa
- Kamuzu College of Nursing, University of Malawi, Malawi
Priscilla Dlamini
- University of Swaziland, Swaziland
Thecla W. Kohi
- Muhimbili University of Health and Allied Sciences, Tanzania
Joseph Mullan
- University of California, San Francisco, United States
Joanne Rachel Naidoo
- University of KwaZulu-Natal, South Africa
Yvette Cuca
- University of California, San Francisco, United States
William L. Holzemer
- University of California, San Francisco, United States
- Corresponding author at: School of Nursing, University of California San Francisco, 2 Koret Way, Box 0608, San Francisco, CA 94143-0608, United States. Tel.: +1 415 476 1504; fax: +1 415 476 6042.

Received 26 November 2008; received in revised form 4 September 2009; accepted 21 September 2009.

Abstract

Background

Descriptive literature exists on the effects of HIV-related stigma on the lives of people living with HIV infection but few empirical studies have measured perceived HIV stigma nor explored its potential relationship to quality of life (QoL) over time in people living with HIV infection.

Aim

A cohort study of a purposive convenient sample of 1457 HIV-positive persons was followed for one year in a longitudinal design that examined the effects of stigma and the life satisfaction dimension of the HIV/AIDS Targeted Quality of Life Instrument (HAT-QOL) over time, as well as the influence of other demographic and assessed social variables. Data were collected three times about six months apart from December 2005 to March 2007.

Results

The average age in this sample was 36.8 years (SD=8.78, n=1454) and 72.7% (n=1056) were female. The initial sample of participants was balanced among the five countries: Lesotho, Malawi, South Africa, Swaziland, and Tanzania. An attrition analysis demonstrated few demographic differences between those who remained in the study 12 months later compared with those at baseline. However, those who completed the study and who answered the QoL questions had significantly higher life satisfaction scores at baseline than those who left the study. There was a general increase in the report of life satisfaction QoL in all countries over the one-year period. However, as stigma scores increased over time there was a significant decrease in life satisfaction with differing rates of change by country. Certain factors had a positive influence on life satisfaction QoL: positive HIV media reports, taking antiretrovirals, reduced symptom intensity, and disclosure to a friend.

Conclusion

This cohort study is the first to document empirically in a longitudinal sample, that perceived HIV stigma has a significantly negative and constant impact upon life satisfaction QoL for people with HIV infection. In the absence of any intervention to address and reduce stigmatization, individuals will continue to report poorer life satisfaction evidenced by reduced living enjoyment, loss of control in life, decreased social interactivity, and decreased perceived health status.

Keywords: HIV/AIDS, Stigma, Quality of life, Africa