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A PATH ANALYSIS OF QUALITY OF LIFE (QOL) AMONG WOMEN LIVING WITH HIV (WLHIV)
M Beaulieu1, M Blais1, J Otis1, G Godin2, JL Roy1, Study Group MAYA1
1Montréal, QC; 2Quebec, QC
Objective: To test a model of the direct and indirect effects of different psychosocial factors on QoL among WLHIV.
Method: Data were gathered from two quantitative studies documenting the QoL of PLHIV in the Montreal area and in 8 other Quebec regions. From 2004 to 2006, 225 WLHIV (mean age = 39.8 years) were recruited through clinics and community organizations. A path analysis model was tested using the MLR estimator available in Mplus 4.5. Factors associated with QoL (MQoL-HIV: mental health and physical functioning subscales, Smith et al., 1997) were: sociodemographic variables (motherhood, country of birth), illness characteristics (taking HAART), HIV disclosure (proportion of people to whom they disclosed), HIV Stigma (HSS: personalized stigma subscale, Berger et al., 2001) and social support (MOS-SSS, Sherbourne & Stewart, 1991).
Results: The final model showed an adequate fit (chi-squared=16.76; df=16; p=0.40; CFI = 0.99; RMSEA= 0.01). Stigma has been found directly and indirectly (via social support) associated with lower mental health. Disclosure has been found directly and indirectly (through stigma) associated to lower values on mental health, whereas country of birth (outside Canada) and social support were associated with higher values. Because motherhood is associated with lower disclosure score, its impact on mental health, while minimal, is favourable. Mental health was positively associated with physical functioning. No significant association has been found between HAART and mental or physical health.
Conclusion: The results suggest that programs enhancing QoL should take into account psychosocial factors related to stigma, disclosure, and social support as well as some sociodemographic variables. As disclosure seems to impair mental health, interventions aiming to help WLHIV manage this everyday burden (linked to other factors associated with QoL) should be designed. Understanding of the complex dynamic of QoL and its interactions with psychosocial predictors is essential to improve services offered to WLHIV.