Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 14343-14346 251

result, quality of life (QOL) from the patient perspective becomes an important
method by which to measure treatment outcomes.
Project: This study compares available QOL questionnaires used for HIV identified in the literature with results from a qualitative study of 150 people living with
HIV/AIDS and participating in in-depth interviews. Respondents were stratified by
disease severity (asymptomatic treated, asymptomatic not treated, mild-moderate
symptoms, and living with AIDS), population (gay men, intravenous drug users,
women, Africans/African Americans/Afro Caribbean, and children), and country
(US, UK, France).
Results: Results from the interviews suggested that the following aspects of life
are affected by HIV/AIDS and/or its treatment: physical functioning, pain, fatigue,
social functioning, cognitive functioning, sex life, feelings/emotions (including depression, anxiety, worry, fear, anger, uncertainty about the future), social and/or
intimate relationships, work, leisure activities, and self-esteem. However, certain
aspects of life were more affected in some groups than in others. A total of 24
generic and 18 AIDS/HIV-specific QOL measures were reported in the literature
to have been used with HIV/AIDS patients. While each questionnaire examined
some quality of life domains mentioned by the interview respondents, no single
measure examined all aspects deemed to be important by the respondents.
Conclusions: No reasonable combination of measures covered all areas mentioned by people living with HIV/AIDS. These findings have important implications
for the selection of questionnaires for clinical trials and academic studies. Findings also have implications for the development of QOL instruments for different
HIV/AIDS populations.
1 4343 Depression, social support, and quality of life in HIV
patients
S.U. Ling1 2, R.D. Moore3, J.C. Keruly3, H.A. Guess2, C.G. Lyketsos3,
B.H. Kaplan2, R.A. Royce2. 'Merch Research Laboratories, BL 2-3, West Point,
PA 19486-0004; 2University of North Carolina, Chapel Hill, NC; 3Johns Hopkins
University, Baltimore, MD, USA
Objectives: To quantitatively describe the relationship of depression and quality
of life measures in a cohort of HIV patients, and to explore the role of social
support in the association of depression and quality of life.
Methods: Five hundred thirty-eight patients (79% response rate) with various
stages of HIV disease were interviewed in the Johns Hopkins Hospital HIV Clinic
(JHHHC). The majority of patients were younger than 45 years old (80%), male
(66%), and black (78%). Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), quality of life was measured using the
Medical Outcomes Study HIV Health Survey (MOS-HIV), and social support was
measured by the Duke-UNC Functional Social Support Questionnaire. Relevant
sociodemographic and clinical data were obtained from the JHHHC database.
Analysis of covariance was used to examine the relationships.
Results: Depressed patients had significantly greater impairment in all domains
of the quality of life measures, when compared with non-depressed patients and
after adjusting for sociodemographic and clinical factors (Mean adjusted score
differences -7.3 to -27.3, p < 0.01 for all 10 domains). Additional adjustment
for social support essentially did not attenuate the associations. Higher level of
social support was associated with better reported health status. The differences
in MOS-HIV functioning domains between high and low social support groups
appeared to be confounded by clinical factors such as symptoms. The differences
in MOS-HIV psychological well-being domains could largely be explained by the
severity of depression as measured by CES-D, suggesting a possible pathway
mediated by depression between social support and quality of life.
Conclusion: Depression has a significant, adverse impact on quality of life in
HIV patients. The study underscores the need for a thorough consideration of HIV
patient's psychiatric status in assessing quality of life and supports the notion that
the psychosocial aspects of HIV disease should be a major focus of care. Further
research is needed to elucidate the mechanism by which social support exerts its
effect on quality of life and as a stress buffer in the context of HIV infection.
143441 Relationship between quality of life and social support in
HIV-infected persons in Venezuela
Yajaira M. Bastardo1' 2, C.L. Kimberlin1. 1 College of Pharmacy University of
Florida, P.O. Box 100496, Gainesville, FL 32610-0496, USA; 2Universidad
Central De Venezuela-UFL,
Objectives: To examine the relationships among health-related quality of life
(HRQL), social support, sociodemographic and health-related factors in HIVinfected persons living in Venezuela.
Design: Survey using a written questionnaire.
Methods: A convenience sample of 106 HIV-infected persons living in the Caracas area, Venezuela was recruited via local HIV support groups and health care
institutions. HRQL, social support, and HIV-related symptoms were assessed using the Medical Outcomes Study Short Form-36 (MOS SF-36), the Interpersonal
Support Evaluation List (Cohen et al, 1985) and a symptom inventory (Cleary et
al, 1993) respectively.

Results: All 3 instruments showed good internal consistency reliability on all
the scales used (alpha > 0.70). Multiple regression analyses were used to model
MOS SF-36 scale scores as a function of social support, symptoms, HIV-status,
age, gender and medication use. The models explained between 11% and 37%
of the variance in the different dimensions of the MOS SF-36. Symptoms was
the best predictor for physical functioning, vitality, health transition, and physical
health summary component. HIV-status was the best predictor for role-physical

and body pain. Social support was the best predictor for social functioning, mental
health, role emotional, and mental health summary component. Age and gender
were not significant predictors of any MOS SF-36 score. As hypothesized, significant differences (p <.05) between HIV+ asymptomatic individuals and HIV+
symptomatic or AIDS individuals were found for all MOS SF-36 scores except
mental health, indicating that the MOS SF-36 was valid in differentiating these
groups in the sample. Mental health was more a function of level of social support
than level of physical symptoms.
Conclusions: Social support and HIV-related symptoms significantly predict
scores on a number of HRQL dimensions. The study provides support for the
reliability and validity of the MOS SF-36 scales in HIV infected individuals in
Venezuela.
14345 1 Better short term self-reported health outcomes for men
with AIDS in fee-for-service vs. managed care systems in
the US
Kathleen Handley', S. Gange Vlahov D.2, C. Flying3, J. Chmiel4, E. Bing5,
S. Riddler6, J.B. Margolick2. 1615 N. Wolfe Street, Rm. E6008 Baltimore,
Maryland 21205; 2Johns Hopskins University, Baltimore, MD; 3MD State AIDS
Administration Baltimore MD; 4Northwestern University, Chicago; 5Drew
University Los Angeles, CA; 6 University of Pittsburgh, Pittsburgh, PA, USA
Objective: To compare changes in self-reported physical health of HIV+ men
treated in managed care organizations (MCO) and fee-for-service systems (FFS)
over a 1 year time period.
Design: A longitudinal study nested in the ongoing Multicenter AIDS Cohort
Study (MACS), 1994-96.
Methods: 570 HIV+ MACS participants provided data on insurance (MCO or
FFS) and either completed the Medical Outcomes Study SF-36 survey at 2 visits
or died within 1 year of completing the survey. Physical component summary
scores (PCS) of the SF-36 were used, and deaths during follow-up were assigned a score of 0. Individuals were classified as having a decline in physical
health status if their PCS score declined more than two standard errors of the
mean (SEM)(5.7). A change of this magnitude has been shown to be clinically
important.
Results: Baseline CD4 counts and PCS scores were similar for both MCO
and FFS groups overall, and also within different disease stages: CD4 > 500,
200-500 or <200, or clinical AIDS. AIDS diagnoses were similar in MCO and
FFS groups although PCP was more prevalent in MCO (40% v. 21%; p =.1).
Overall, declines in self-reported physical health status were similar for the MCO
and FFS groups (30% v. 32%, respectively). However, among men with an AIDS
diagnosis at the baseline visit (n = 81), declines in physical health status were
more common in MCO (n = 20) than in FFS participants (n = 61) (90% v. 65%; p
<.03). Among men with CD4 < 200 or AIDS at baseline (n = 178), self-reported
physical health status was more likely to decline in MCO (n = 48) than in FFS
participants (n = 130)(64% v. 50%; p =.1). Similar trends were seen when deaths
were removed from the analysis. Utilization of reverse transcriptase inhibitors
(RTI) was similar between MCO and FFS; however fewer men in MCO than in
FFS were taking combination RTI, both overall (13% v. 22%; p <.05), and for
men with AIDS (20% v. 46%; p <.06).
Conclusions: During a one year follow-up period, among men with an AIDS
diagnosis, those in MCOs experienced a greater decline in self-reported physical
health status than those in FFS.
14346 Learning to live with HIV through self help
Ramapandian Ramasamy, A. Pillai. Tamilnad Network Of Positive People
(TNP+), PDO. Box 2720, Chennai, India
Issue: Improving quality of life of people living with HIV/AIDS by instilling confidence and self esteem.
Project: TNP+ started disseminating its existence through mass media,
HIV/STD clinics & NGOs. After a needs assessment a booklet on Nutrition
and Healthy living was published and distributed to PLWHA and care givers. A
series of workshops were conducted on the issues of quality of life (QOL). Six
workshops with an average of 20 PLWHA participating were conducted. Increasing participation of PLWHA (50% women) in programs and increasing number
of PLWHA membership in TNP+ is a testimony to their confidence. One of the
key achievements of the support group is enabling self esteem to its members.
The openness with which PLWHA are able to meet other positive persons and
provide testimony about their lives convey belief that they can continue to live
is another evidence to the elevated self esteem. These process have elevated
self confidence and self esteem and has led several PLWHA to disclose their
status to their families thereby getting the much needed family support leading to
improvement of their QOL.
Results: PLWHA can organise ourselves to share experiences and plan the
pursuit of QOL. These Increase and elevate self confidence and self esteem and
thereby lead to a better QOL among PLWHA.
Lessons Learned: PLWHA can not be brought together is a Myth. Narrow

minded prevention programs should change to broad minded community support.
Shared confidentiality enables family and community support. Formation of self
help group is critical and should be encouraged. More external support should be
given to PLWHA group to continue self help programs. Programs addressing care
for PLWHA should include support towards enabling coming together of PLWHA.