Vulnerable populations among people with HIV: sociodemographic factors associated with health-related quality of life

Abstract

Health-related quality of life (HRQoL) is a key outcome in managing people with HIV. This study examined how sociodemographic factors relate to HRQoL. People with HIV from a Dutch treatment center completed a questionnaire assessing eight HRQoL domains: general health, anxiety and depression, social support, stigma, sexuality problems, self-esteem, sleeping difficulties and side effects. Sociodemographic factors included gender, age, education, employment, religion, marital status, sexual orientation, sex of sexual partners, and year of HIV diagnosis. Multivariable regression assessed associations, and an intersectional multilevel analysis (MAIHDA) evaluated intersectionality. Among 271 participants (mean age 47.6 years), most identified as male (84.5%) and homosexual (62.7%). Median time since HIV diagnosis was 10 years. Older age was associated with higher self-esteem, and lower education with more sleeping difficulties. Unemployment, heterosexual orientation, and sexual inactivity were associated with poorer HRQoL. Specifically, unemployment was linked to worse outcomes across most domains, while sexual inactivity was associated with greater stigma, less social support, and more sexuality problems. MAIHDA analysis revealed that intersecting sociodemographic factors explained up to 24.6% of HRQoL variance, particularly in mental, physical, and general health. Routine HRQoL assessment in HIV care enables the identification of vulnerable individuals and guides personalized interventions.