Kaohsiung Journal of Medical Sciences (2015) 31, 485e492

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ORIGINAL ARTICLE

Stress, needs, and quality of life of people living

with human immunodeficiency virus/AIDS in
Taiwan
Ming-Chu Feng a, Jui-Ying Feng b, Chien-Tai Yu a, Li-Hua Chen a,
Pei-Hsuan Yang b, Chung-Ching Shih c, Po-Liang Lu d,e,*

a
Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical
University, Kaohsiung, Taiwan
b
Department of Nursing, College of Medicine, National Cheng Kung University and Hospital,
Tainan, Taiwan
c
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
d
Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung,
Taiwan
e
College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Received 21 April 2014; accepted 2 July 2015

Available online 18 August 2015

KEYWORDS Abstract Human immunodeficiency virus (HIV)/AIDS is a manageable infectious disease by

Needs; the effectiveness of highly active antiretroviral therapy. AIDS-related stigma and conflict
People living with may create distress and deteriorate quality of life (QoL) of people living with HIV/AIDS
human (PLWHA). This cross-sectional, descriptive, correlational study using structural questionnaires
immunodeficiency aimed to explore the stress, needs, QoL, and associated factors of PLWHA in Taiwan. A total of
virus/AIDS; 200 PLWHA participating in this study needed most on treatment of HIV and prevention of AIDS,
Perception; and health maintenance. They had worse QoL in physical, psychological, and social domains
Quality of life; (all p < 0.001) than the general population. Stress was the most significant predictor (b Z
Stress
0.25 to
0.54, p < 0.01) for all four domains of QoL. Needs was not significantly associated
with QoL. The QoL of PLWHA can be explained by demographics, self-perception on health,
needs, and stress for 25.3e40.7% of variances. No association existed between CD4 counts
and QoL in Taiwanese PLWHA. It is important to recognize the perception of PLWHA on their
health status, which is significantly associated with their QoL, besides monitoring their phys-
ical indicators of health (CD4 counts). To recognize the stress and needs that PLWHA

Conflicts of interest: All authors declare no conflicts of interest.

* Corresponding author. Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou
1st Road, Kaohsiung City, Taiwan.
E-mail address: d830166@cc.kmu.edu.tw (P.-L. Lu).

http://dx.doi.org/10.1016/j.kjms.2015.07.003
1607-551X/Copyright 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.
486 M.-C. Feng et al.

experience and to develop intervention programs targeting strategies on HIV disclosure, pre-
vention and health maintenance are crucial for PLWHAs QoL.
Copyright 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights
reserved.

Introduction it varied in degree by individual cultural contexts and

The number of human immunodeficiency virus (HIV)-infec-
ted people continues to increase worldwide since the first
AIDS patient was identified in 1980. However, highly active
antiretroviral therapy has significantly reduced the AIDS
related mortality rate [1]. HIV infection has become a
chronic disease [2].
Quality of life (QoL), a multidimensional concept, is now
recognized as a significant indicator for the health and
many aspects in the lives of people living with HIV/AIDS
(PLWHA) due to the chronicity of AIDS. AIDS stigma and
discrimination were found to be significantly related to the
QoL of PLWHA in all stages. Compared with noninfected
individuals, PLWHA in all disease stages demonstrated a
poor QoL in all aspects, especially in psychological and
social aspects [3e5]. In literature, the poorer QoL of PLWHA
was associated with the more severe disease condition,
lower CD4 T cells count, longer treatment time, poor
mental health, no family support, being older, being fe-
male, and lower educational and economic levels, although
available medical care in different countries [6e14].
The only report about QoL and stress among Taiwanese
PLWHA in 2003 identified that stress was related to mood
disturbance, poor social support, physical-symptom
distress, and self-perceived mode of HIV transmission.
The predictor of QoL was the source of financial support
[15]. We re-examined the QoL, stress, and its predictors
among Taiwanese PLWHA because of the improvement in
AIDS care with time, and the initiation of the case manager
service in 2006 and needle exchange program in 2005 might
change the stigma of PLWHA, stress, and QoL. Due to the
chronicity of AIDS, how to keep PLWHA in the medical
system is an important problem. To meet the needs of
PLWHA, we need them to stay in the medical system [16].
We believed the importance of stress, needs, and QoL of
PLWHA cannot be ignored in the continuing HIV care, and
that there is a paucity of only one study to investigate all
the three issues. Therefore, we aimed to investigate stress,
needs, and QoL of PLWHA and the associated factors of
QoL, stress, and needs in Taiwan.

Demographics

Demographics
Disease related
1. Hospitalization
2. AIDS QoL
Stress
3. Current health
4. Deteriorating Disease related
health 1. Hospitalization
2. AIDS
3. Current health
Mental health
4. Deteriorating
1. Stress
health
2. Need

Demographics

Disease related
Needs
1. Hospitalization
2. AIDS
3. Current health
4. Deteriorating health

Figure 1. The framework of researchdquality of life (QoL), stress, and needs.

Stress, needs, and QoL of PLWHA in Taiwan 487

Table 1 Demographics and perception of health, social Table 1 (continued )

relationships, and caregivers of people living with human
Item n (%)
immunodeficiency virus/AIDS.
Worse 19 (9.5)
Item n (%)
BS Z Bachelor of Science.
Sex
Male 192 (96)
Female 8 (4)
Marital status Methods
Single 178 (89)
Married 14 (7)
This cross-sectional, descriptive, correlational study aimed
Divorced or separated 8 (4)
to explore the associated factors of stress, needs, and QoL
Level of education
among PLWHA in Taiwan (Figure 1). We recruited PLWHA
BS or higher 131 (65.5)
who were aged 18 years or older at the clinics and wards in
High school 50 (25)
a medical center in southern Taiwan from January 2009 to
Junior high school or lower 19 (9.5)
January 2010. Approval was obtained from the Institutional
Unemployment or change 36 (18)
Review Board at the researchers institution. After
Family structure
receiving informed consent from patients, a structured
Nuclear family 162 (81)
questionnaire was used to collect data.
Stem or extended family 17 (8.5)
Other 21 (10.5)
Hospitalization due to AIDS 62 (31)
CD4 count  200  106/L 74 (37) Measures
Opportunistic infection 18 (9)
Transmission route The study questionnaire was designed to measure stress,
Homosexual contact 166 (83) needs, and QoL of PLWHA. The demographic part includes
Heterosexual contact 23 (11.5) personal information, disease and diagnosis related infor-
Bisexual contact 1 (0.5) mation, such as familys awareness of patients diagnosis,
Injection drug use 10 (5) reasons for revealing diagnosis to family, relationship with
Self perception on health family before and after diagnosis, change or loss of
Poor 59 (29.5) employment, current health status and health change after
Average 83 (41.5) the diagnosis date, laboratory data (CD4 and HIV viral
Good and excellent 68 (34) load), hospitalization history, and routes of opportunistic
Self perception of health change infections or transmission.
A lot worse 39 (19.5) Stress and needs scales were developed for this study.
Worse 68 (34) The stress scale, comprising 25 items and divided into five
Same 67 (33.5) aspects (physical, psychological, economic, social, and
Better 17 (8.5) limitation in daily life), was constructed based on litera-
A lot better 9 (4.5) ture review to measure the stress level in PLWHA. Items
Living with family 118 (59) were scored using a five-point scale from 0 (never) to 4
Family knows the diagnosis 104 (52) (always). The possible total score ranges from 0 to 100.
Disclosure reasons The higher scores indicate higher perceived stress. The
Faith in support 52 (50) needs scale also consists of 25 items in five aspects
Involuntary by hospitals 36 (34.6) (physical, psychological, economic, social, and nutrition
Involuntary by health department 9 (8.7) and diet). Items were scored using a four-point scale from
Involuntary by military 1 (0.9) 0 (no need) to 3 (very much needed). The possible total
Missing 6 (5.8) score ranges from 0 to 75 with higher scores indicating
First to notify higher perceived needs. The need source scale is used to
Parents 72 (69.2) evaluate the sources that PLWHA encountered. The scale
Spouse 10 (9.6) contained three items including their preferred sources,
Siblings 20 (19.2) the preferred methods to meet their needs, and the ways
Other (partner) 2 (1.9) the healthcare workers informed them of their illness.
Main caregiver Items were scored using a four-point scale from 0 (no need)
Parents 85 (42.5) to 3 (very much needed). The content validity indexes
Spouse 13 (6.5) based on six experts pointed for the content of the need
Siblings 7 (3.5) scale about relevance, correctness, and appropriateness of
Other 29 (14.5) rated wording from very suitable (4 points) to very inap-
None 65 (32.5) propriate (1 point). The content validity indexes were
Change in relationship with family after disclosure 95.7% for the stress scale and 97.7% for the needs scale. A
Better 19 (9.5) preliminary reliability test was carried out with 50 pa-
Same 162 (81) tients, and the Cronbach a was 0.92 for the stress scale and
0.933 for the needs scale.
488 M.-C. Feng et al.

Patients QoL was measured using the WHOQOL-BREF

3.18**

3.59**

4.08**
4.34**
(World Health Organization Quality of Life), the WHOQOL

.76

0.22

1.66
0.33

1.01
0.26
0.41

0.40

0.34
t
Environmental
Taiwan Version [17] with 28 items in four domains. Cron-
bach a values were 0.91, 0.76, 0.70, 0.72, and 0.77 for the
total scale, physical, psychological, social, and environ-

Mean (y/n)
13.8/12.5
13.3/13.4
13.2/13.9
13.4/13.3
13.2/13.6
13.4/13.3
13.4/13.3
13.5/13.2
13.2/13.4
13.3/13.4
12.3/13.6
12.4/13.7
12.8/14.0
mental domains, respectively. The testeretest reliabilities
were >0.75, and the criterion-related validities ranged
from 0.53 to 0.78 (p < 0.01).

2.64**

2.76**

3.92**
Statistical analysis

2.04*
Social relationships

0.68

1.27
0.82

1.59
0.69

0.46
0.67
0.26

0.43
t
Descriptive statistics (mean, standard deviation, fre-
quency, and percentage) were used to describe patients

Mean (y/n)
13.1/12.4
13.0/12.7
12.8/13.3
13.0/12.7
12.6/13.1
13.1/12.8
12.8/12.9
13.1/12.8
13.0/12.9
12.8/12.9
12.0/13.1
12.1/13.1
12.3/13.5
characteristics and variables. Inferential statistics and the
Z test were used to examine relationships between vari-

Quality of life
ables and comparison of QoL with the general population.
Demographic information, education, family structure,
CD4 count, and health status before and after infection,

2.77**

3.28**

4.13**
Psychological health

1.95
1.39

1.27
0.66

0.38
1.23

0.03
0.69

0.71

0.26
were dummy coded in the regression analyses.

*p < 0.05; **p < 0.01. The t and p values were compared with/without demographics among stress, need and quality of life.
Results

Mean (y/n)
12.5/11.8
12.4/11.9
12.1/12.7
12.4/12.1
12.2/12.3
12.6/12.1
12.2/12.3
12.4/12.1
11.8/12.3
12.2/12.3
11.2/12.5
11.2/12.6
11.6/13.0
Demographics

A total of 200 PLWHA agreed to participate in this study.

Table 1 describes demographic information. The majority

3.41**

2.97**

5.45**

6.48**
Testing of mean scores for stress, needs, and four domains of quality of life (n Z 200).

2.14*

2.50*

2.77*

1.14

0.51

0.34

0.84

0.24

1.51
were male (96%), single (89%), had a Bachelor of Science
Physical health

(BS) degree or higher (65.5%), with a mean age of t

32.7  8.43 years. Thirty-six (18%) PLWHA had changed jobs
Mean (y/n)

due to AIDS-related issues. Homosexual contact resulted in

13.9/13.1
13.5/13.9
13.6/13.8
13.3/14.1
13.2/14.1
13.5/13.7
13.5/13.7
13.6/13.7
12.8/13.7
12.8/14.0
12.6/13.8
11.9/14.2
12.7/14.7
the most infection (83%). The CD4 counts of PLWHA were
284.3  224.9  106 cells/L, and 37% had a CD4 count
below 200  106 cells/L. Eighteen cases (9.0%) had suffered
from opportunistic infections, mostly tuberculosis and
0.83
1.36
1.75
1.12

0.27
1.32
0.27

0.86

0.51

1.59
0.30
1.27
0.69
Pneumocystis jirovecii pneumonia.
t

The major family structure for our study was nuclear

family (81%). Most (59%) lived with their original family. Fifty-
Needs

Mean (y/n)
46.5/44.9
46.8/44.2
46.7/42.7
46.8/44.7
45.7/46.2
48.0/45.2
46.2/45.7
44.7/46.4
44.5/46.1
43.8/46.9
46.5/45.8
48.0/39.3
46.5/45.3
two percent of family members of PLWHA knew about their
diagnosis of HIV. Parents were the largest group as caregivers
(63.4%) and the first to whom patients in this study revealed
their illness (69.2%). Hospitalization was not associated with
HIV disclosure (p > 0.05; Table 2). Changes in the relationship
2.95**
3.61**
2.07*

between PLWHA and their families were associated with

1.40
0.69
0.80
0.91
1.05
0.13

0.67

0.60

1.27
0.28
t

families being notified about the AIDS status (c2 Z 8.84,

p Z 0.012). The descriptive information of stress, needs, and
Stress

four domains of QoL is presented in Table 3.

Mean (y/n)
40.0/43.3
41.7/40.0
41.6/39.3
42.0/39.9
42.3/39.9
41.4/41.1
40.3/41.8
40.2/41.6
36.8/41.6
41.6/40.9
47.3/39.8
46.8/39.3
44.8/37.0

BS Z Bachelor of Science; y/n Z yes/no.

Stress

Participants felt most stressful about making their HIV/AIDS

AIDS-related unemployment
Hospitalization due to AIDS

status public, not knowing how to tell people about their

Family knows AIDS status

Parent as main caregiver

illness, unpredicted health, being rejected, spreading HIV

Opportunistic infection
Demographic (yes/no)

to family or friends, and family/friends being stigmatized

Deteriorating health
Voluntary disclosure
BS degree or higher

CD4  200  106/L

(Table S1).
Live with family
Nuclear family

Needs
Poor health
Religion
Table 2

Participants indicated a need to know about how to care for

the illness. Needs, ranked in order, were: (1) examination
and treatment information; (2) health maintenance
Stress, needs, and QoL of PLWHA in Taiwan 489

Relationships among demographics, health factors,

Table 3 Description and Cronbach a of stress, needs, and
four domains of quality of life. stress, needs, and QoL
Mean (SD) Range a
The T test statistics were used to examine the associations
Stress 41.1 (15.81) 0e91 0.92 of demographic information on stress, needs, and QoL
Needs 46.0 (14.76) 4e75 0.93 (Table 4). Age, sex, religion, and family structure were not
Quality of life 57.9 (8.80) 33e82 0.91 associated with stress, needs, and QoL. PLWHA with a col-
Physical 13.6 (2.35) 6 e19 0.76 lege degree (BS) or higher scored higher in three QoL do-
Psychological 12.3 (2.63) 5e19 0.70 mains: physical health (p Z 0.034), social relationships
Social 12.9 (2.23) 4e19 0.72 (p Z 0.043), and environment (p < 0.001). The physical
Environmental 13.4 (2.24) 8e20 0.77 QoL of PLWHA was negatively associated with living with
SD Z standard deviation. family and disclosure of HIV/AIDS diagnosis to family.
Compared with those with stable employment, PLWHA who
experienced employment loss or change owing to health
condition significantly scored higher in stress level, but
lower in all four domains of QoL.
information; (3) medication side effects information; (4)
We also measured health-related factors (i.e., CD4 and
opportunistic infection prevention; and (5) professional
opportunistic infection) to examine its contribution to
counseling (Table S2).
needs, stress, and QoL of PLWHA. PLWHA who have been
hospitalized reported an inferior physical QoL. PLWHA who
Sources of needs perceived a worse health condition scored significantly
higher in stress, but lower in QoL for all domains.
Participants were asked about their AIDS-related informa-
tion source, the desired means to receive information, and Regression
favorable attitudes from physicians when informing them of
their illness. The doctor (85%) was most helpful in providing Multiple hierarchical regression analyses were used to
knowledge and information, followed by the nurse (78%), examine the impacts of demographics, health factors,
social worker (28.5%), and others. Participants preferred to needs on stress and QoL, as well as stress on QoL in three
be informed face-to-face by professionals (80%) or by models (Table 5). For parsimony, the independent variables
telephone consultation when needed (62.5%). Most patients in each model were selected based on the tests of means
(68%) expressed a wish not to inform their family when their and correlations. Stress was the most significant predictor
illness becomes terminal. Moreover, 26.5% believed that (b Z
0.25 to
0.54, p < 0.001) for QoL in four domains.
AIDS information posted on the Internet provided the The QoL of PLWHA can be explained by demographics, self-
greatest help, and 25.5% also wish to obtain AIDS-related perception of health, needs, and stress for 25.3e40.7% of
information through the Internet (Table S3). variances.

QoL Discussion

The Z test revealed that PLWHA scored significantly lower
in physical, psychological, and social domains, but no dif-
ference was found in the environmental domain, when
compared with the general population. However, family
members of PLWHA had significantly lower scores in social
and environmental domains than PLWHA. There was no
significant difference in physical health and psychological
health [18] (Table 4).
The results of our study indicate that PLWHA generally
demonstrated poor QoL, and their stress was the most
significant single factor for this. The stress level of PLWHA
has a significant contribution to QoL. For PLWHA, stress was
correlated with QoL in many countries [19e21]. Most of the
stressful events of PLWHA were financial problems and the
death of a friend or relative [21]. Healthcare providers in
hospitals and in the community should pay more attention

Table 4 Comparison of quality of life of patients with quality of life of family members of people living with human immu-
nodeficiency virus/AIDS (PLWHA) and the general population (Z test).
PLWHA General population Pa PLWHA family pb
Case no. 200 213 50
Physical health 13.6  2.35 (6e19) 15.4  1.81 <0.001 13.2  2.38 >0.05
Psychological health 12.3  2.63 (5e19) 13.7  2.07 <0.001 11.6  2.53 >0.05
Social relationships 12.9  2.23 (4e19) 14.0  2.10 <0.001 12.2  1.96 0.033
Environmental 13.4  2.24 (8e20) 13.1  2.18 >0.05 11.8  2.21 <0.001
a
Comparison between patients and general population [17].
b
Comparison between patients and family members of PLWHA [18].
 490
Table 5 Effects of demographics and selected variables on stress, needs, and quality of life.
Predictors Quality of life
Stress Physical health Psychological health Social relationships Environmental
Model 1 Model 2 Model 3 Model 1 Model 2 Model 3 Model 1 Model 2 Model 3 Model 1 Model 2 Model 3 Model 1 Model 2 Model 3
Demographics
Education BS higher/lower
0.07
0.08
0.09 0.10 0.09 0.06 0.12 0.13 0.08 0.11 0.12 0.08 0.27** 0.29** 0.27**
Live with family yes/no 0.07 0.07 0.03
0.16*
0.15*
0.12* 0.03 0.04 0.07 0.06 0.07 0.09 0.02 0.02 0.04
Family knows patient has AIDS 0.04 0.03 0.03
0.14*
0.08
0.07
0.00 0.02 0.03
0.09
0.08
0.07
0.01
0.01 0.00
Job loss due to health 0.18* 0.11 0.11
0.20**
0.08
0.04
0.18*
0.10
0.04
0.17*
0.09
0.05
0.19**
0.11
0.08
Disease-related
Hospitalization due to AIDS
0.05 0.00
0.11
0.14* 0.05 0.03 0.05 0.04 0.09 0.07
Current health: bad 0.12 0.08
0.27**
0.22**
0.13
0.08
0.10
0.05
0.18*
0.14
Deteriorating health 0.16* 0.16*
0.25**
0.20**
0.20*
0.11
0.19*
0.13
0.16*
0.12
Mental health
Stress d
0.35**
0.54**
0.42**
0.25**
Needs 0.38**
0.04 0.09 0.10
0.07
DR2 5.2% 14.1% 20.1% 12.3% 10.2% 23.3% 5.6% 13.8% 7.3% 7.6%
R2 4.7% 9.9% 24.0% 9.1% 28.5% 40.7% 5.3% 12.3% 35.7% 6.0% 11.6% 25.3% 12.4% 19.7% 27.4%
*p < 0.05; **p < 0.01. Model 1 predictors: education BS or higher; live with family; family knows patient has AIDS; and job loss due to health. Model 2 predictors: education BS or higher;
live with family; family knows patient has AIDS; job loss due to health; hospitalization due to AIDS; current health poor; and deteriorating health. Model 3 predictors: education BS or
higher; live with family; family knows patient has AIDS; job loss due to health; hospitalization due to AIDS; current health bad; and deteriorating health, stress, needs. BS Z Bachelor of
Science.

M.-C. Feng et al.

Stress, needs, and QoL of PLWHA in Taiwan
when stressful events occurred to PLWHA. We found that
needs was not significantly associated with QoL of PLWHA,
although it was significantly related to stress. Furthermore,
recognizing the PLWHAs perception of health status is
important that significantly correlated with their QoL.
The Cronbach a values on the four domains of QoL were
>0.7, which indicates a good intercorrelation among the
measured items. Cronbach a values > 0.9 revealed that the
internal consistency of the items in the stress scales, needs
scales, and QoL domains are even better.
Unlike findings in several studies [13,17,22], our study
found that PLWHA had poor physical QoL if they had a
history of living with family, being hospitalized for AIDS
related events or disclosure. It suggested the role of family
as the caregivers when PLWHA were physically sick.
Approximately 59% of PLWHA in this study lived with their
families. Our results revealed that family is the chief
caregiver of PLWHA, as is the situation in Malaysia [22]. Of
PLWHA in this study, 52% disclosed their AIDS status to their
family, which is less than the rate reported in a Malaysian
study [22]. It indicated the PLWHA in Taiwan were not used
to disclosing their AIDS status to their family.
Despite many studies finding that individuals with CD4
count <200  106/L had poor QoL [4,22], this study was
consistent with Tiwari et al. [3] in that no association
existed between CD4 counts and QoL. The increased CD4
counts helps to reduce HIV-related physical symptoms but
not the symptom of depression. The effect of self-
perception and psychological distress on individual QoL
cannot be overlooked.
Almost one in five PLWHA in our study had lost or
changed their employment due to AIDS-related problems.
Consistent with a Canadian study [7], the result of our study
demonstrated employment was strongly associated with
the stress level and QoL in all four domains. Unemployment
or financial instability creates anxiety or insecurity for
PLWHA, especially for the young or middle-aged adults who
were expected to be the most productive and contributive
age group to family economics. Lost or changed employ-
ment status owing to health deterioration or discrimination
creates a vicious circle to PLWHA health and QoL.
Similar to the previous studies [12e14], participants
with higher education levels (BS or higher) reported better
QoL in physical, social, and environmental domains. The
contribution of education is particularly prominent in the
environmental domain. Lower education level may often be
associated with a lower economic status; PLWHA with
higher education might have better income and live in
better conditions.
More than one half of the participants in the study felt
that their health condition was worse than they were
before. This result reflects that the needs of PLWHA mainly
focused on health maintenance and illness care. The desire
of PLWHA to self care for physical needs was very strong.
Consistent with previous literature [8e10,22,23], the re-
sults of this study also indicated that PLWHA were most
stressed about disclosure, exposure, discrimination, dis-
ease contagion, and unpredictable health condition. Stra-
tegies concerning disclosure, HIV prevention, and health
maintenance are critical for PLWHA to reduce stress, meet
needs, and improve QoL. Although most preferred face-to-
face consultation, about 25% of participants in this study
491
favored the Internet as a source to obtain information and
knowledge about AIDS care. Health informatics in AIDS
prevention and care should be further developed for its
popularity and privacy. Those PLWHA who preferred the
Internet as the main method to access their required in-
formation may benefit from better on-line informatics,
while the case managers and healthcare workers may pro-
vide adequate information to meet the needs of PLWHA.
The results of this study were in agreement with a study
in China [4]: the QoL of PLWHA was inferior to that of the
general population. However, PLWHA reported better QoL
when compared with that of family members of PLWHA in
Taiwan in our previous study [18], especially in social and
environmental domains in Taiwan. The possible reasons
may be that medical accessibility in Taiwan provides care
and support for PLWHA, whereas family members had fewer
sources from physicians and case managers. There was no
statistical difference in physical and psychological
domains.
This study is limited because the majority of the par-
ticipants in this study were male. We cannot explore the
sex difference in stress, needs, and QoL in the study.
Women may respond very differently in relation to their
roles in the family and society. The QoL of female PLWHA
and associated factors deserve further exploration. In
addition, a study design on the dyad of both PLWHA and
caregivers can help observe the dynamic relationships of
stress and QoL between patients and caregivers across the
different stages of illness. Most of the PLWHA in the report
were men who have sex with another men (MSM). The QoL
scores of MSM were found to be lower than those of general
residents [24]. We did not investigate the impact of MSM on
QoL in the study. A further study on the difference of QoL
between MSM with HIV/AIDS and MSM without HIV/AIDS is
warranted.
In conclusion, this study indicates that PLWHA in Taiwan
had poor QoL and felt very stressful about revealing diag-
nosis, unpredictable health condition, and HIV trans-
mission. There is a need to recognize the stress and needs
that PLWHA experienced and to develop intervention pro-
grams targeting strategies on disclosure, HIV prevention,
and health maintenance to enhance QoL for PLWHA.
Acknowledgments
This research was supported by a grant from the Kaohsiung
Medical University Hospital, grant number KMUH98-8G15.
We sincerely thank the study participants for their
contribution.
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Appendix A. Supplementary data
Supplementary data related to this article can be found at
http://dx.doi.org/10.1016/j.kjms.2015.07.003