The highest proportion (54.3%) of the total respondents in this study was within age group 38 and above years. This suggests that age group (38 and above) is an important risk group in HIV epidemic in Enugu State, Nigeria. Majority (77.5%) of the respondents’ quality of life was excellent. This could be as a result of the fact that majority of the respondents (73.5%) were in WHO HIV clinical stage 1, and high proportion of them (68%) were not ill at the time of this study. Over half of the participants (56%) in a multi-ethnic study17 rated their QoL as ‘good or very good’. In contrast, in United Kingdom, people living with HIV have significantly lower QoL than do the general population.18 QoL of HIV positive patients is also significantly low in Xin-jiang, West China.19 However, in Ho municipality Ghana, 79.75% presented with excellent overall QoL respectively.14 In Cross River State, Nigeria,20 majority of the respondents rated their QoL scores as good (46.3%), very good(17.1%). Also, majority of the patients (84.7%) attending a HIV clinic in Lagos, Nigeria perceived their quality of life to be good.21 However, significant proportion of HIV positive patients on ART in Uyo,22 Nigeria (78.5%) perceived their overall QoL to be poor.
The respondents’ perception of their QoL regarding different aspects of health was varied. Majority (61.8%) of the respondents’ physical condition was poor. This could be attributed to loss of weight associated with HIV infection. Also, mentally and physically, HIV positive patients attending ART clinics are not as healthy as their healthy neighbours.14 In UK, physical health mean scores for HIV patients receiving treatment was higher than scores in other health domains.23 But in India,24 the quality of life score was lowest for physical condition of the HIV patients receiving treatment. In other aspects of health, a high proportion of the respondents (75.8%) in this study had good psychological feeling, 72% of the respondents consider their relationship with their environment to be good, 60% had excellent level of independence, almost half (49%) of the patients had excellent social relationship, , while 92.5% of them had very poor level of spirituality.
Similar respondents in a study done in India25 reported highest QoL score in spirituality/religion/personal belief domain than in physical, psychological, social, and level of independence domains. In contrast, in Ibadan, Nigeria,26 Kwara State Nigeria,27 the social domain recorded the lowest mean score. In Sao Paulo Brazil, worst average scores were reported in the Environment and Level of independence domains,28 while in Burkina Faso,29 the Environment and Level of independence domains also had lower scores compared to other quality of life domains. In Kogi state, north-central Nigeria,30 respondents that participated in similar study reported lower scores in the environmental and social domains.
Gender and educational factors did not influence the quality of life of the respondents in this study. However, similar studies done in Nigeria20,26,30, showed that gender influenced the quality of life of the respondents. In Kogi State, Nigeria,30 female HIV patients have a higher QoL score when compared to their male counterparts in all domains. Studies done in Cross River State20 and Ibadan26 in Nigeria did not report any significant difference in QoL scores between males and females living with HIV/AIDS and receiving care at ART clinics.
Married or widowed respondents in this study had better excellent quality of health than those who were separated or single. Similarly, in Ilorin, Kwara State, Nigeria,27 HIV sero-positive married women have the highest QoL scores in all the domains compared to those with a different marital status. Also, in Uyo, South South Nigeria,31 HIV positive patients who are single, separated or widowed have poor QoL in social and environmental domains. Respondents who are 38 years or above had the best quality of life, while those within the age group 18 to 22 years had the worst quality of life. Similarly, in China,32 and Iran,33 older age is also associated with a high QoL score. In contrast, in Portugal,34 older people (40years and above) living with HIV have lower QoL in a number of domains (physical, level of independence, and social relationships). QoL of HIV patients in Croatia is also improved by being of younger age.35 Also in United States of Americaa,36 younger age is associated with better QoL among HIV positive patients.
In increasing magnitude, stigmatization, social relationship, psychological feelings, physical condition of the patient, and lack of money reduces the QoL of the respondents in this study. Respondents in this study with better health had high quality of life, while those who were ill had the least quality of life. This may be because HIV patients with poor medical history are inclined to have worse QoL.32 This can also explain why respondents in similar study done in India,37 reported better daily routine activities (level of independence) and social activities in asymptomatic patients compared to those with AIDS defining symptoms. Similarly, in Bangladesh,38 it was observed that asymptomatic HIV patients have better QoL that permits them to still perform their normal activity. Among HIV positive patients on ART in Uganda, number of visits to clinic, level of education, WHO HIV stage and level of depression are determinants of physical health score.39 Also, symptomatic HIV patients in Ghana,14 and Nigeria,26 significantly presented with a lower overall quality of life.
In Brazil, having acquired opportunistic infections were predictors associated with a poorer quality of life.40 It has also been observed in various studies across the world,19,41,42 that stigmatization lowers QoL scores. Social support is also positively associated with the QoL of HIV/AIDS patients.43,44,45 It has been observed in India,25 and Brazil,28 that presence and severity of symptoms are associated with lower physical domain score and overall QoL of HIV patients. In Ghana, HIV patients’ self-appraisal of their health significantly predicted their quality of life, with lower QoL recorded among those who perceived themselves as ill.14 In United States of Americaa,36 younger age, higher income, and better social relation and support are associated with better QoL among HIV positive patients.
A high proportion (68.3%) of the respondents in this study was satisfied with their physical condition. Also, 75.8% were satisfied with their psychological feelings, 78.8% were satisfied with their ability to perform daily activities, and 77.5% were satisfied with social relationship with other people. A high proportion (78.5%) of the respondents was also satisfied with the environment of where they were living. This is because most of the respondents in this study are in WHO HIV stage 1, and were not suffering from serious HIV co-infection diseases. However, remarkably, in Vietnam,46 the proportions of respondents completely satisfied with overall service quality and treatment outcomes at HIV clinics were 42.4% and 18.8%, respectively. Also, in Southern Ethiopia, 46.4% of HIV positive patients attending ART clinic were satisfied with the services they received.47 Similar study done in Cross River, Nigeria,20 showed that majority of the respondents(48%) were ‘satisfied’ with their health.