| SignificancesBy the end of 2011, the population of people who were infected with HIV was about 34 million worldwide, the number in China was about 7800 thousand, which seemed that the global AIDS epidemic was still severe nowadays. Some medicine which aimed at preventing the virus from reproduction comes out, had greatly lowered the infection rate and death rate, and prolonged the infectors’ life span. However, being infected not only affects people’s physical health, but also affects their psychological health and their relation with others, which affects people’s life quality. It is becoming an important research topic for the experts to improve HIV infectors/AIDS patients’life quality while prolonging their life span.International research on the HIV infectors/AIDS patients have a long history and a deep exploration, it has already been very complete in terms of methodology as well as content, while domestic research is relatively a bit late. Domestic research adopt the internationally accepted standard, it appears various in research method, and complete in contents, while the depth remains to be dug. The AIDS patients’ life quality research focuses on the psychological health and the social support, the research object is different groups of people, e.g. female, minorities, male homosexual, and prisoners, and the scope is expanding. While the research on the life quality comparison between AIDS patients and normal people and the causes is many, the research on comparison between people who receive antiviral therapy and those who don’t is few.It is known that receiving antiviral therapy as early as possible contributes to the health of patients, which will lower the chance of transmit the virus to other people. However, experts don’t agree on which group would have better life quality. Based on the field survey in Dali city on HIV infectors, we had found that the difference between the people who were in antiviral therapy group and those who don’t is obvious, but there were few research on the relevant causes of the different life quality between the two groups of people. On the other hand, it was known that the infectors in antiviral therapy group were mainly supervised and administrated by AIDS-designated hospital while the non-in-group infectors mainly administrated by Centers for Disease Control and Prevention. So our studying team decided to have a deeper exploration on the differences of life quality influencing factors between these two groups for the sake of providing scientific data and support for related supervision department.Materials and MethodsThis study was a cross-sectional survey conducted in Dali, Yunnan Province. From the first person registered in local Disease Prevention and Control Center from April of 2008, we continually counted 460 HIV infectors as objects of our investigation, among which 230 person had been included into the antiviral therapy group, and the other 230 person were not. We use self-made questionnaire to ask the respondents’ studying sociology population status, physical health status, psychological status (sense of shame), social support, social environment, the quality of life and other information. Use "HIV Stigma scale" for sense of shame, "Social Support Rating scale" for social support, "WHOQOL-BREF scale" for life quality. In date analysis, the general characteristics of investigators were showed in description; t test/analysis of variance (quantitative data) or chi square test (count data) for hypothesis testing; single factor linear regression analysis for single factor analysis; stepwise regression method in multiple linear regression analysis to investigate the affected factors of life quality.ResultsA total of 442 questionnaires were acquired,223 were the infectors not in antiviral therapy group, and the other 219 were in group. The ratio of men to women was close to 3:2. Their average age was 41.75±11.29 years old. Bai people were nearly as many as the Han nationality. Most of them were at junior high school level of education or below and 16.5% of them had been divorced. Quarter of them were keeping housework as job or just staying at home waiting for work. Their average annual income was 10535.50 yuan. The whole group had been infected HIV virus for 3.43±2.28 years on average. As to results of recent test of CD4+T cell,33.6% were between 200-350/mm3, and 19.9% 0-199/mm3. One fifth of the infectors had opportunistic infections already. Among the people in antiviral therapy group, one third had toxic and side effect after taking medicines. The total sore of Stigma scale they got was 114.26±15.20. Their total score of Social Support scale is 31.63±7.71 on average. Their average household population was 3.21±1.34, and 67.9% of their family income was from work. Heterosexual transmission was given priority to all routes of transmission, counted for two thirds, and followed injection of drugs, for about one third. Half of the respondents had been in medicine insurance of New Rural Co-operative Medical System. The grand average score of all respondents’ quality of life was 48.77±8.27.Through multi-factor analysis, the factors affected their quality of life were "present annually income", "whether take part in antiviral therapy or not", "personalized stigma", "be afraid of disclosure", "subjective support" and "support use rate". Compared to not in antiviral therapy group, people in group were more at age of young adults, higher education level, with higher percentage keeping housework or just staying at home waiting for work and longer time been infected. They had less CD4+T cells but lower percentage of having opportunistic infection. The infectors in group had fewer family member, more were infected with drug injection, with higher ratio participating in Urban Worker Medical Insurance or the Urban Residents’. What’s more, respondents in group got higher score of stigma, as well as the use rate of social support. But their score of life quality were lower, especially on physiology area, psychology area and environmental area. Further, it was found that factors affected the people not in group mainly were "present annually income", "personalized stigma", "disclosure", "subjective support", and "support use rate". As to respondents in group, factors were just "present annually income" and "subjective support".Discussion and suggestionIn this study, it was found that the overall respondents’quality of life score was not as high, not only lower than the healthy group and high risk group, but also lower than HIV-infected people in other similar research in China, no matter on area of physiology, psychology, social relationship or environmental, which indicated that HIV-infected in Dali of Yunnan province were not at good state of life quality, they were under quite heavy pressure at present. For the overall respondents, the one who has taken part in antiviral therapy group, with lower annually income, meanwhile has strong personalized stigma, be more afraid of disclosure, has less social support and the lower support use rate would be in poorer quality of life. It is suggested that related departments and medical workers should pay more attention on HIV infectors who have characteristics mentioned above, provide them with reasonable psychological guidance and health education, as well as appropriate social support and help them establish healthy ways to cope, so that access to social identity and improve their quality of life.Through multi-factor analysis, it was found that the respondents who were in antiviral therapy group had worse quality of life than the ones who not in group. Moreover, the infected who had higher annually income, with more subjective support and higher support use rate, their quality of life were better, on the contrary, the respondents who got higher score on personalized stigma and disclosure areas, quality of life worse. When compared the factors affected quality of life with two groups of people, it is found that factors influenced the people in group mainly focused on their financial situation and the social support they got, but for people not in group not only affected by their financial situation and the social support but also their stigma.So for the infector who has not been taken part in antiviral therapy group, the early health education on taking part in antiviral therapy group timely is strongly recommended. At the same time, strengthen coordination and cooperation of HIV/AIDS related departments, to the whole society especially for the medical worker, follow close to internationally protective principles and decrease the discrimination for the HIV infectors. More over, carry out health education and health promotion as well as the intervention activities in community and public places aiming to establish the positive image of HIV infected people and patients, reduce discrimination against them and build a relatively loose social atmosphere. Meantime, for the infectors that reject cares should be paid more attention, help them to accept themselves and rebuild their confidence of life step by step, so that improve their quality of life. As to the infectors who has been in antiviral therapy group, peer education is suggested, which can help their family members know more knowledge related to HIV/AIDS spread ways or non-spread ways, as well as providing psychological counseling and so on, in order to reduce family’s fear and exclusion to them and improve the family support for them. At the same time, more investment in HIV/AIDS prevention and control of national governments is suggested, and the funds could be raised through various channels. What’s more, pertinence AIDS insurance system should also be established,so that the HIV infectors could be served better and sustainability. |
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