Relationship between stigma and health-related quality of life in patients diagnosed with HIV
More details
Hide details
School of Social and Human Sciences, Universidad Externado de Colombia, Bogotá, Colombia
Department of Psychology, School of Social Sciences, Universidad de los Andes, Bogotá, Colombia
Submission date: 2020-06-26
Final revision date: 2020-10-29
Acceptance date: 2021-03-05
Publication date: 2021-08-26
HIV & AIDS Review 2021;20(3):179-186
Human immunodeficiency virus (HIV) epidemic is one of the main problems in public health, and health-related quality of life (HRQoL) is usually negatively affected. Stigma is one of the factors related to a lower HRQoL.

Material and methods:
We aimed to assess this relationship, and felt stigma was measured using HIV felt stigma scale, while HRQoL was measured with EORTC QLQ-C30. We interviewed 140 patients, and 10.9% of our respondents reported feeling severe stigma, 25.4% moderate stigma, 26.1% mild stigma, and 37.7% absence of stigma.

Average score for overall HRQoL was 83.3 (SD = 21.4). Higher levels of stigma were associated with lower levels of perceived global HRQoL (β = –0.32, p = 0.001). Moreover, higher levels of stigma were correlated with a lower physical function (β = –0.27, p = 0.005), role function (β = –0.28, p = 0.001), cognitive function (β = –0.30, p = 0.001), social function (β = –0.32, p = 0.001), and emotional function (β = –0.60, p < 0.001).

Reducing felt stigma could help improve HRQoL in HIV-positive patients.

The United Nations Joint Programme of HIV/AIDS (UNAIDS). Fact sheet – Global AIDS update 2019. Geneva: UNAIDS, 2018. Available from:
The United Nations Joint Programme of HIV/AIDS (UNAIDS). Report on the global HIV/AIDS epidemic. Geneva: UNAIDS 2018. Available from:
Aggleton P, Parker R, Maluwa M. Stigma, discrimination and HIV/AIDS in Latin America and the Caribbean. Washington, Inter-American Development Bank; 2002.
Estrada-Montoya JH, Escobar-Leguízamo DN, Briceño-Castellanos JF. Educación de pares como estrategia de prevención de la infección por VIH en adolescentes: referentes teóricos y metodológicos. Revista de Gerencia Política en Salud 2011; 10: 46-66.
Oguntibeju OO. Quality of life of people living with HIV and AIDS and antiretroviral therapy. HIV AIDS 2012; 4: 117-124.
Passos S, Souza LD. An evaluation of quality of life and its determinants among people living with HIV/AIDS from Southern Brazil. Cad Saúde Pública 2015; 31: 800-814.
Enimil A, Nugent N, Amoah C, Norman B, Antwi S, Ocran J, et al. Quality of life among Ghanaian adolescents living with perinatally acquired HIV: a mixed methods study. AIDS Care 2016; 28: 460-464.
Global Network of People Living with HIV (GNP+). The People Living with HIV Stigma Index 2015. Available from:
NAPWA SA. HIV Leadership through Accountability Programme: GNP+, NAPWA SA. PLHIV Stigma Index OR Tambo Region Assessment, Germiston, NAPWA SA. 2012 Available from:
Kalichman SC. The harms of internalized AIDS Stigma: a comment on Tsai et al. Ann Behav Med 2013; 46: 256-257.
Jiménez JC, Morales M, Castro E, Puig M, Vélez CN, Santiago L, et al.. Levels of Felt Stigma among a Group of People with HIV in Puerto Rico. Puerto Rico Health Sciences Journal 2012; 31: 64-70.
Tsai A, Bangsberg DR, Weisser SD. Harnessing poverty alleviation to reduce the stigma of HIV in sub-Saharan Africa. PLoS Med 2013; 10: e1001557.
Turan B, Budhwani H, Fazeli PL, et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV Stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS Behav 2017; 21: 283-291.
Hays RD, Reeve BB. Measurement and modeling of health-related quality of life. In: Heggenhougen K, Quah S (eds.). International Encyclopedia of Public Health, 241-252. San Diego: Academic Press; 2008.
Pozniak A. Quality of life in chronic HIV infection. Lancet 2014; 1: 6-7.
Engelhard E, Collete S, van Dijk P, et al. Health-related quality of life of people with HIV: an assessment of patient related factors and comparison with other chronic diseases. AIDS 2018; 32: 103-112.
Nobre N, Pereira M, Roine RP, Sutinen J, Sintonen H. HIV-related self-stigma and health-related quality of life of people living with HIV in Finland. J Assoc Nurses AIDS Care 2017; 29: 254-265.
Rueda S, Mitra S, Chen S, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open 2016; 6: e011453.
Li X, Huang L, Fennie K, Williams A. Stigma mediates the relationship between self-efficacy, medication adherence, and quality of life among people living with HIV/AIDS in China. AIDS Patient Care STDS 2011; 25: 665-671.
Bermúdez-Román V, Bran-Piedrahita L, Palacios-Moya L, Posada-Zapata IC. Influencia del estigma en torno al VIH en el acceso a los servicios de salud. Salud Pública Mex 2015; 57: 252-259.
Tamayo-Zuluaga B, Macías-Gil Y, Cabera-Orrego R, Henao-Peláez J, Cardona-Arias J. Estigma social en la atención de personas con VIH/sida por estudiantes y profesionales de las áreas de la salud, Medellín, Colombia. Rev Cienc. de la Salud 2015; 13: 9-23.
Tran BX, Phan HT, Latkin CA, et al. Understanding Global HIV Stigma and Discrimination: Are Contextual Factors Sufficiently Studied? (GAPRESEARCH). Int J Environ Res Public Health 2019; 16: 1899.
Rubio Mendoza ML, Jacobson JO, Morales-Miranda S, Sierra Alarcón CA, Luque Núñez R. High HIV burden in men who have sex with men across Colombia’s largest cities: findings from an integrated biological and behavioral surveillance study. PLoS One 2015; 10: e0131040.
Jiménez JC, Puig M, Ramos JC, et al. Measuring HIV felt stigma: a culturally adapted scale targeting PLWHA in Puerto Rico. AIDS Care 2010; 22: 1314-1322.
Aaronson NK, Ahmedzai S, Bergman B, et al. The European-Organization for Research and Treatment of Cancer QLQ-C 30. A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365-376.
Finck C, Barradas S, Singer S, Zenger M, Hinz A. Health related quality of life in Colombia: Reference values of the EORTC QLQ-C30. Eur J Cancer Care 2012; 21: 829-836.
Shaik F, Uldrick YS, Esterhuizen T, Mosam A. Health-related quality of life in patients treated with antiretroviral therapy only versus chemotherapy and antiretroviral therapy for HIV-associated Kaposi sarcoma: a randomized control trial. J Glob Oncol 2018; 4: 1-9.
Cabrera SG, Arteta Z, Meré J, Cavalleri F. Calidad de vida relacionada a la salud en personas con VIH y factores asociados. Rev Méd Urug 2018; 34: 7-19.
Fayers P, Aaronson N, Bjordal K, Groenvold M, Curran D, Bottomley A. EORTC QLQ-C30 Scoring Manual. Third. Brussels: EORTC; 2001.
Green SB. How many subjects does it take to do a regression analysis? Multivariate Behav Res 1991; 26: 499-510.
Centers for Disease Control and Prevention. HIV Surveillance Report; 2017. Available from
Varni SE, Miller CT, McCuin T, Solomon SE. Disengagement and engagement coping with HIV/AIDS stigma and psychological well-being of people with HIV/AIDS. J Soc Clin Psychol 2012; 31: 123-150.
Yaya I, Djalogue L, Patassi AA, et al. Health-related quality of life among people living with HIV/AIDS in Togo: individuals and contextual effects. BMC Res Notes 2019; 12: 140.
Finck C, Barradas S, Zenger M, Hinz A. Quality of life in breast cancer: associations with optimism and social support. Int J Clin Health Psychol 2018; 18: 27-34.
Sprangers M, Schwartz C. Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med 1999; 48: 1507-1515.
Dinkel A, Nather C, Jaeger H, et al. Stigmatization in HIV/AIDS: first German adaptation of the HIV-stigma scale (HSS-D)]. Psycho­ther Psychosom Med Psychol 2014; 64: 20-27.
Zarei N, Joulaei H. The impact of perceived stigma, quality of life, and spiritual beliefs on suicidal ideations among HIV-positive patients. AIDS Res Treat 2018; 2018: 6120127.
Liu H, Xu Y, Lin X, Shi J, Chen S. Associations between perceived HIV stigma and quality of life at the dyadic level: the actor-partner interdependence model. PLoS One 2013; 8: e55680.
Burclau R, Umlauf A, Luca A, et al. Sex based differences in neurocognitive functioning in HIV infected young adults. AIDS 2018; 32: 217-225.
Charles B, Jeyaseelan L, Pandian AK, et al. Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India. A community based cross-sectional study. BMC Public Health 2012; 12: 2-11.
Maki P, Rubin L, Springer G, et al. Differences in cognitive function between women and men with HIV. J Acquir Immune Defic Syndr 2018; 79: 101-107.
Journals System - logo
Scroll to top