Marseille 2007
| Abstract #221 - Positive futures? HIV infection and achieving health, wealth and future planning | ||||
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Session: 42.3: Wellbeing and quality of life (Parallel) on Tuesday @ 16.30-18.30 in Auditorium/Overflow Chaired by Anna Liguori, Richard Harding Authors: Presenting Author: Mr Richard Harding - Kings College, United Kingdom |
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| Additional Authors: Mr Tim Molloy, | ||||
| Aim: As new treatments cast HIV disease as a chronic condition, there is an increasing expectation that those with HIV live economically productive and fulfilling lives. However, it is unclear what conditions or interventions are viewed by those affected as necessary to achieve this. | ||||
| Method / Issue: In this mixed methods study, a focus group of gay men living with HIV was conducted to identify relevant domains for enquiry. Following content analysis of the qualitative data, an online survey was designed and piloted. The cross-sectional self-complete survey included open and closed items, and the MSAS-SF psychological and physical symptom measurement tool. | ||||
| Results / Comments: 347 gay men with diagnosed HIV infection completed the survey, mean age 37.5 (SD 8.3), CD4 count= 459 cells x 106/l (median=426), and 208 (59.9%) had an undetectable viral load. 210 (56.6%) were currently on antiretroviral therapy (ART). Employment status had significantly changed from prior to diagnosis to the time of the survey: reducing from 305 (87.9%) to 203 (58.5%) in paid employment; increasing from 12 (0.03%%) to 67 (19%) unemployed; and increasing from 5 (1.44%) to 36 (10.3%) retired. The majority (57.8%) felt that HIV had reduced their career options and also that believed that their life expectancy is reduced (n=252, 71.8%). In multivariate analysis, belief in reduced life expectancy was associated with younger age (b=0.150, p=0.014) and worse psychological symptom distress (b=0.172, p= 0.016) but not with time since diagnosis or being on treatment. Avoiding exposure to HIV and other STIs was seen as not important by n=165 (62.3%) and n=95 (35%) respectively. However, 85.3%) felt that it was possible to become infected with a different strain of HIV if that had unprotected sex. Themes generated from open ended responses to the question What do you need in order to achieve your goals for the future were strongly interrelated. The primary theme was that of support and reducing discrimination (n=38), including emotional and practical support from friends, the gay community, other HIV-positive people, voluntary and statutory agencies, and family. A further dominant theme was the need for improved clinical care (n=27): a stronger clinical focus on detecting and treating mental health problems (n=9); an imperative to maintain good general health, with emphasis on maximising energy levels, fighting fatigue, and keeping a strong positive outlook to minimise the effects of depression (n=10), and an improvement in the side effects and effectiveness of anti-HIV treatments (n=8). The need for emotional relationships and partnerships was described (n=11), as were barriers to gaining paid employment (n=21) and associated financial insecurity (n=25), including direct experiences of discrimination in the workplace related to homophobia and HIV infection, being economically unable to move off welfare into paid employment, advice and training, and workplace adjustments that take into account the needs of people with HIV. The final identified need was to build personal skills and resources (n=30). | ||||
| Discussion: These data demonstrate the need for multidimensional strategies to ensure that, in the era of treatments, people live with HIV can pursue full integration and personal fulfilment. Both policy and clinical care need to respond to these articulated needs. As incidence of HIV rises, and people live longer with new treatments, it is essential to ensure that those living with HIV are not socially excluded. | ||||
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