Quality of life of men with AIDS and the model of social determinants of health

cross-sectional study conducted in an outpatient infectious diseases clinic from a Brazilian university hospital over the course of one year with a sample of 138 patients. A form based on the MSDH was used to collect sociodemographic data addressing individual, proximal, intermediate determinants and the influence of social networks together with an instrument used to assess the QoL of people with HIV/AIDS. The project was approved by the Institutional Review Board (Protocol No. 040.06.12).

RESULTS:

according to MSDH, most men with AIDS were between 30 and 49 years old (68.1%), mixed race (59.4%), heterosexual (46.4%), single (64.5%), Catholic (68.8%), had a bachelor's degree (39.2%), had no children (61.6%), and had a formal job (71.0%). The perception of QoL in the physical, level of independence, environment, and spirituality domains was intermediate, while QoL was perceived to be superior in the domains of psychological and social relationship. A perception of lower QoL was presented by homosexual (p=0.037) and married men (p=0.077), and those with income below one times the minimum wage (p=0.042). A perception of greater QoL was presented by those without a religion (p=0.005), living with a partner (p=0.049), and those who had a formal job (p=0.045).

CONCLUSION:

social determinants influence the QoL of men with AIDS.

HIV; Acquired Immunodeficiency Syndrome; Health Promotion; Quality of Life; Nursing

Layers according to the Model of Social Determinants of Health			n (%)
1. Individual determinants
	Age group (in years)*
		≤ 29 years old	17 (12.3)
		30-49 years old	94 (68.1)
		≥ 50 years old	27 (19.6)
	Race
		Caucasian	42 (30.4)
		Afro descendant	14 (10.2)
		Mixed	82 (59.4)
2. Proximal determinants
	Category of exposure
		Heterosexual	64 (46.4)
		Homosexual	55 (39.9)
		Bisexual	19 (13.7)
	Marital status
		Single	89 (64.5)
		Married/stable union	39 (28.2)
		Others (divorced, widowed)	10 (7.3)
	Religion
		Catholic	95 (68.8)
		No religion	10 (7.3)
		Other	33 (23.9)
	Schooling^†
		Illiterate	7 (5.1)
		Middle School	39 (28.2)
		High school	38 (27.5)
		Bachelor’s degree	54 (39.2)
3. Influence of social networks
	Number of children^‡
		No children	85 (61.6)
		1 – 2	37 (26.8)
		≥ 3	16 (11.6)
	Number of household members§
		1 – 2	57 (41.3)
		3 – 5	65 (47.1)
		≥ 6	16 (11.6)
	Lives with a partner
		Yes	80 (58.0)
		No	58 (42.0)
4. Intermediate determinant
	Occupation
		Has a formal occupation	98 (71.0)
		No formal occupational	21 (15.2)
		Other	19 (13.8)
	Income per capita^\|\|
		< 1 times the minimum income	5 (3.6)
		1 - 2 times the minimum income	53 (38.4)
		> 2 times the minimum income	80 (58.0)

WHOQOL-HIV Bref’s domains	Mean ± Standard deviation	Median	Minimum value	Maximum value
I. Physical	14.68 ± 3.28	15.00	7	20
II. Psychological	15.32 ± 2.51	15.20	6.4	19.2
III. Level of independence	13.86 ± 2.87	14.00	5	20
IV. Social relationships	15.50 ± 2.80	16	7	20
V. Environment	14.40 ± 2.12	14.50	9	18.50
VI. Spirituality	14.09 ± 3.88	13.50	7	20

Social Determination Model of Health			Scores obtained for the WHOQOL-HIV bref domains (Mean ± Standard Deviation)
Social Determination Model of Health			I	II	III	IV	V	VI
Layer 1
	Age group (in years)
		≤ 29	15.5 ± 3.3	15.2 ± 2.8	14.2 ± 2.3	16.4 ± 2.3	14.5 ± 2.0	13.4 ±4.4
		30-49	15.0 ± 3.3	15.5 ± 2.5	14.0 ± 2.8	15.4 ± 2.9	14.5 ± 2.1	14.2 ± 3.9
		≥ 50	13.5 ± 2.7	14.9 ± 2.2	13.0 ± 3.1	15.4 ± 2.3	14.1 ± 2.0	14.0 ± 3.5
		P value	0.223	0.159	0.676	0.739	0.788	0.211
	Race (self-reported)
		Caucasian	14.5 ± 3.0	14.9 ± 2.9	13.7 ± 2.7	15.2 ± 3.0	14.5 ± 1.9	13.1 ± 4.3
		Afro descendant	15.2 ± 3.2	15.4 ± 2.1	14.3 ± 3.1	15.5 ± 2.3	13.9 ± 2.4	14.7 ± 2.9
		Mixed	14.8 ± 3.3	15.5 ± 2.3	13.7 ± 2.9	15.7 ± 2.7	14.4 ± 2.1	14.4 ± 3.8
		P value	0.790	0.427	0.801	0.847	0.621	0.241
Layer 2
	Sexual Orientation
		Heterosexual	14.4 ± 3.2	15.6 ± 2.0	13.5 ± 3.0	15.5 ± 2.7	14.0 ± 2.1	14.8 ± 3.7
		Homosexual	14.4 ± 3.2	15.0 ± 2.7	14.2 ± 2.8	15.5 ± 2.7	14.8 ± 1.9	12.9 ± 4.1*
		Bisexual	15.6 ± 3.2	15.5 ± 3.0	13.8 ± 1.8	15.6 ± 3.1	14.5 ± 2.2	14.5 ± 3.4
		P value	0.598	0.555	0.263	0.956	0.103	0.040
	Marital status
		Single	14.7 ± 3.2	15.2 ± 2.6	14.0 ± 2.6	15.7 ± 2.7	14.7 ± 2.0	13.7 ± 3.9
		Married/stable union	15.1 ± 3.4	15.9 ± 2.1	13.4 ± 2.4	15.5 ± 2.6	13.7 ± 2.3^†	15.0 ± 3.8
		Divorced	13.9 ± 2.6	14.5 ± 2.7	13.4 ± 2.4	14.2 ± 3.4	14.3 ± 1.1	13.7 ± 3.5
		P value	0.525	0.154	0.379	0.300	0.040	0.229
	Religion
		Catholic	14.6 ± 3.1	15.0 ± 2.5	13.6 ± 2.9	15.5 ± 2.9	14.3 ± 2.1	13.6 ± 3.6
		Other	14.3 ± 3.3	15.8 ± 2.3	13.6 ± 2.7	15.2 ± 2.6	14.5 ± 2.1	14.5 ± 4.3
		No religion	18.0 ± 2.5^‡	17.2 ± 1.6^§	16.0 ± 2.0^\|\|	17.1 ± 1.6	15.7 ± 1.5	16.6 ± 4.4
		P value	0.003	0.013	0.049	0.137	0.123	0.056
	Schooling
		Illiterate	14.4 ± 3.7	15.6 ± 1.7	14.0 ± 2.9	15.0 ± 2.5	14.0 ± 1.6	15.4 ± 3.8
		Middle school	14.0 ± 2.7	15.3 ± 2.2	13.2 ± 2.7	15.0 ± 2.5	14.2 ± 2.2	13.4 ± 3.7
		High school	15.4 ± 3.0	16.0 ± 2.1	13.4 ± 2.6	16.1 ± 2.5	14.3 ± 2.0	15.1 ± 4.0
		Bachelor’s degree	14.9 ± 3.6	14.9 ± 2.9	14.5 ± 3.0	15.6 ± 3.0	14.7 ± 2.0	13.6 ± 3.9
		P value	0.241	0.153	0.315	0.235	0.504	0.05

Model of Social Determinants of Health			Scores obtained for the WHOQOL-HIV bref’s domains (Mean ± Standard deviation)
Model of Social Determinants of Health			I	II	III	IV	V	VI
Layer 3
	Number of children
		No children	14.7 ± 3.1	15.2 ± 2.6	14.2 ± 2.7	15.6 ± 2.7	14.5 ± 2.0	13.9 ± 4.0
		1 – 2	15.1 ± 3.4	15.6 ± 2.2	13.3 ± 2.8	15.4 ± 3.1	14.1 ± 2.0	13.9 ± 3.8
		≥ 3	14.5 ± 3.2	15.3 ± 2.6	13.1 ± 3.6	15.3 ± 2.0	14.4 ± 2.4	15.1 ± 3.7
		P value	0.874	0.772	0.261	0.863	0.598	0.547
	Number of household members
		1 – 2	15.0 ± 3.3	15.2 ± 2.1	13.9 ± 2.7	15.6 ± 2.4	14.4 ± 2.1	14.1 ± 4.0
		3 – 5	14.7 ± 3.3	15.6 ± 2.1	14.0 ± 2.7	15.9 ± 2.4	14.6 ± 2.1	13.8 ± 4.0
		≥ 6	14.1 ± 2.9	14.7 ± 3.0	12.6 ± 3.4	14.0 ± 2.9	13.5 ± 1.9	14.9 ± 3.6
		P value	0.715	0.413	0.218	0.054	0.196	0.597
	Lives with partner
		Yes	14.6 ± 3.2	15.2 ± 2.6	14.0 ± 2.5	15.5 ± 2.8	14.7 ± 1.9*	13.7 ± 3.9
		No	15.2 ± 3.3	15.8 ± 2.1	13.5 ± 3.3	15.5 ± 2.7	13.9 ± 2.2	14.8 ± 3.7
		P value	0.280	0.155	0.153	0.867	0.049	0.158
Layer 4
	Occupational situation (whether has a formal job contract)
		Formal job	15.1 ± 3.2	15.7 ± 2.3^†	14.2 ± 2.6^‡	15.2 ± 2.8	16.6 ± 2.0	14.3 ± 4.3
		No formal job	14.0 ± 3.1	14.3 ± 3.0	12.5 ± 3.3	15.3 ± 3.0	13.6 ± 2.4	13.7 ± 3.9
		Other	14.6 ± 3.4	14.9 ± 2.3	13.0 ± 2.9	15.5 ± 2.5	14.2 ± 1.7	13.1 ± 3.4
		P value	0.359	0.045	0.015	0.841	0.142	0.360
	per capita income in minimum wage (MW)
		< 1 MW	15.7 ± 2.7	15.1 ± 2.1	13.0 ± 2.5	13.8 ± 2.7	12.0 ± 1.4^§	15.5 ± 4.0
		1 -2 MW	14.2 ± 3.3	15.1 ± 2.7	13.2 ± 2.7	15.5 ± 2.4	14.1 ± 2.2^\|\|	13.6 ± 3.9
		˃ 3 MW	15.0 ± 3.2	15.6 ± 2.3	14.3 ± 2.9	15.7 ± 2.9	14.9 ± 1.8	14.2 ± 3.9
		P value	0.372	0.232	0.059	0.066	0.001	0.762

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Gilmara Holanda da Cunha Universidade Federal do Ceará. Departamento de Enfermagem Rua Alexandre Baraúna, 1115 Bairro: Rodolfo Teófilo CEP: 60430-160, Fortaleza, CE, Brasil E-mail: gilmaraholandaufc@yahoo.com.br

Brasil

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Quality of life of men with AIDS and the model of social determinants of health1 1 Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil, process # 476514/2012-6

OBJECTIVE:

METHOD:

RESULTS:

CONCLUSION:

Quality of life of men with AIDS and the model of social determinants of health¹ 1 Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil, process # 476514/2012-6