According to the findings of this study, the mean QoL score was 52.5 out of 100. The QoL score was lower in patients with higher external and internal stigma scores and those who were employed while it was higher in divorced or widowed patients versus single ones. In addition, the lowest mean was related to financial worries, health worries, and disclosure worries while the highest mean was related to the dimensions of provider trust, medication concerns, and overall activity.
In assessing the QoL dimensions, the lowest mean scores were related to the dimensions of financial worries, health worries and disclosure worries while the highest mean scores were related to the dimensions of provider trust and medication concerns. These findings are consistent with the findings of studies conducted in northwestern Sao Paulo (2018), southwest of Minas Gerais (2018) and Pelotas (Brazil 2017) in which the lowest scores were related to the domains of financial and confidential concerns and the highest scores were related to physician trust and drug concerns (10–12).
As for financial worries, its importance may be explained by the low purchasing capacity of the study participants, considering that an unprivileged socioeconomic level may negatively affect the individual’s life and survival. Regarding the confidential concerns, similar results were reported by Soares et al. (2015) who observed that HIV-positive individuals might not seek health services for fear of discrimination resulting from the stigma caused by the disease. As a consequence, many adopt a life of duplicity in which they keep their immunologic condition a secret from friends and family and also neglect self-care (8). A high score in the domains of trust in service provider and drug concerns may indicate that patients at this center have good relationships with service providers. They receive the necessary training and are satisfied with the performance of the service providers.
The results of this study showed that divorced and widowed patients had a higher QoL compared to single patients. These results are inconsistent with the findings of studies conducted in Spain (2011) and China (2015) that found that single patients, those who lived alone, and the patients who did not have children had higher QoL scores (13, 14). Moreover, the results of a study conducted in Finland in 2017 showed that married people and those who lived with a partner had a higher QoL, which is inconsistent with the results of the present study (15). Married people may have a lower QoL because they and their spouses have HIV and both suffer from the disease while divorcees and widows do not suffer from this additional pressure.
The present study showed a lower QoL in patients who were employed. The results of studies conducted in Iran (Fars Province), Finland, and Zimbabwe showed a higher QoL who in employed subjects, which is inconsistent with the present study (15–17). One of the reasons for this inconsistency could be that they are constantly worried that their colleagues and others may learn about their disease and that they will lose their job because of their disease. Moreover, they may experience a higher stigma from their colleagues.
The results revealed a lower QoL in patients who experienced higher external and internal stigma scores, which is consistent with studies conducted in Tanzania, South Indian, Spain, and Iran (Tehran) (3, 18, 19). External stigma, which includes the actual experience of prejudice, discrimination, and exclusion described by stigmatized people, has a direct negative influence on the QoL (18). Internalized stigma is likely to make an individual more sensitive to both actual and anticipated rejection and stigmatization by others, which negatively affects disclosure (20).
This study had two limitations. First, the information was collected from individuals who presented to two centers in a city; therefore, the results may not be extrapolated to those who did not present to these centers or to centers in other cities. Second, this study had a cross-sectional design, which cannot prove causality.