Predicting quality of life for people living with HIV: international evidence from seven cultures.

The need for a validated quality of life (QOL) model focussing on people living with HIV/AIDS has led to an international re-evaluation and extension of the Chronic Illness Quality of Life model using complex latent modelling techniques. After reoperationalising six model variables and including independence and sex-life, the WHOQOL-HIV was administered to 1281 people with asymptomatic-HIV (42%), symptomatic-HIV (40%) or AIDS (18%; 34 years; 62% male) living in Australia, Brazil, India (north & south), Italy, Thailand and Ukraine. The overall model fit was acceptable. Social inclusion did not directly improve QOL, but increased positive feelings, social support and perceived improvements of access to health and social care; all three improved QOL. Social inclusion increased perceived physical health indirectly through positive feelings. Better physical health improved sex-life and gave greater independence; both improved QOL. Gender and disease stage models were acceptable, fitting best for men and asymptomatic-HIV. Similar aspects of QOL were depleted for women and some disease stages. Increased social support did not consistently improve independence or positive feelings. Positive feelings improved the sex-life of men and those with asymptomatic-HIV. This cross-cultural approach combining assessment with theory, could guide future international interventions and practice.