ISGH 3 | Vol 3. No. 1 | Oktober 2019 | ISSN: 2715-1948
DIFFERENCES OF QUALITY OF LIFE BETWEEN MEN AND WOMEN OF REPRODUCTIVE AGE SUFFERING HUMAN IMMUNODEFICIENCY VIRUS
INFECTION BY USING THE INSTRUMENT WHOQOL - HIV BREF IN CLINIC MAWAR BANDUNG CITY
Vera Iriani Abdullah*, Wiryawan Permadi, Hadi Susiarno [email protected]
Master of Midwifery Study Program, Public Health Sciences Department, Faculty of Medicine Padjajaran University, Bandung Indonesia
ABSTRACT
Health development is an essential effort implemented by all components, refers to the RPJMN 2015-2019 which is to improve the control HIV/AIDS infection which is classified in communicable diseases because of the tendency of increased prevalences in the population aged 15-49 years. Sexually transmitted infections play role as the mode of entrance of HIV infection in the body which remains during the life time. Stigma and social discrimination still attributed to people with HIV infection impacts the social and psychological status between men and women which can directly affect the quality of life. Measurement quality of life using WHOQOL- BREF instrument to determine the burden of disease and the success of health services as a reference of long- term management for people with HIV/AIDS. This study aims to analyse the differences of quality of life between reproductive age men and women in terms of physical health, psychological health, Self-Reliance, social relations, environment, spiritual and general health.
This study was an observational analytic study with cross-sectional design. The population was people infected HIV in Bandung. The sample of the study was 60 respondents aged 20-40 years old, chosen by non probability sampling with consecutive sampling technique. The study was conducted in March to April 2018. The data analysis used was Kolmogorov Smirnov test. The result of the analysis showed that the P value on Physical Health, Psychological Health, Self-Reliance, Social Relation, Environment, Spiritual, general Health and total score quality of life greater than 0.05 (P>0.05). This means insignificant or not statistically significant. The conclusion of this study was that there was no difference in the quality of life between reproductive age men and women with HIV infection.
Keywords: Quality of life, reproductive age, HIV/AIDS, communicable disease
INTRODUCTION
The main target of the National Medium-Term Development Plan 2015-2019 is to improve disease control, including communicable diseases Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome due to a tendency of increased prevalence among population aged 15-49 years. Globally, the World Health Organization estimates the incidence rate of new infections at 18.2 per 100,000 population. In Indonesia the cumulative number of HIV cases from 1987 to March 2017 was around 10,376 people. West Java is the second highest number of HIV cases within period January-March 2017 which was around 1,505 people, the biggest contributor was Bandung City with total of 2,112 people. The suspect cause is promiscuity, high sexual activity among adolescents, and sexual deviant behavior. Men and women infected by HIV will receive different social
and psychological impacts, women are more prone to suffer from HIV infection because men are fully in control of sexual activity. Woman generally have less control over safe sexual activity and decision making.
Stigma and discrimination tend to be more inherent in women than men. They are blamed for bringing HIV into the family. Higher levels of depression in women are significantly associated with lower quality of life and are associated with adherence to antiretroviral therapy and poor physical health outcomes. Therefore, it is important to address gender inequality. Studies on the differences in quality of life between men and women have been widely carried out in the general population. Nevertheless, the study population in contrast to this study which focuses on reproductive age population, which has the highest incidence rates. Social impacts, gender inequality, social
support, psychological pressure, independence, environmental, spiritual, physical and psychological conditions, mental well-being, stigma, and discrimination are factors that significantly affect the quality of life.
Measurement of quality of life must utilise valid, reliable, responsive and precise instrument. In this study, WHOQOL-BREF Instrument was used because it has been used in medical practice, research, auditing and policy making in 23 countries and has been translated into 20 languages in the world including Indonesia. This quality of life research is very important because it can be used in the long-term management of care for people with HIV/AIDS, and is able to provide a symptomatic change to assess the level of disease so that it plays an important role in the sustainability of care, adherence to anti-retroviral (ARV) therapy, and survival.
METHODs Study Design
The study was a cross-sectional design method, that is a method that measures the independent and dependent variables at the same time. This design also utilise to study the dynamics of the relationship between risk factors and their effects. The study was conducted from March 19 to April 19, 2018 in Clinic Mawar, Bandung City.
Samples
The sampling technique used non-probality sampling technique with consecutive sampling method. The formula for determining the sample size for unpaired categorical analytical research taken from the sample size 2.0 program from Hosmer and Lemeshow which was obtained and a total sample of 60 respondents consisted of 30 men and 30 women.
Instrument
The research instrument used the Indonesian version of the WHOQOL-HIV BREF questionnaire, consisting of 31 question items covering 7 domains namely physical health, psychological health, independence, social relations, environment, spirituality and general health.
Data Collection Procedure
Data collection was done after ethical clearance obtained from the Ethics Committee of the Faculty of Medicine, Padjadjaran University, Bandung. Before filling out the questionnaire respondents were given informed consent. If they agreed then they could sign the consent form, then fill out the WHOQOL-HIV BREF questionnaire Data analysis
The data analysis aimed to in investigate the dependent and independent variables. Numerical data were presented with the mean, standard deviation, median, and range. Meanwhile, the characteristic of the respondents were categorical data, such as gender and patient occupation so that data presented as frequency and percentage distribution. Prior to the numerical data statistical tests, normality tests were performed using the Saphiro-Wilk test. If the data is less than 50 respondents, the alternative is Kolmogorov- Smirnov. In accordance with the research objectives and hypotheses, a significance test was performed to compare the characteristics of the two research groups using an unpaired t-test if the data were normally distributed and the Mann Whitney test as an alternative statistical test if the data were not normally distributed. The significance criteria used are the p value. If p≤0.05 is statistically significant and p>0.05 is not statistically significant. The data obtained was recorded in a special form and then processed through the SPSS program version 24.0 for Window.
RESULT
Table 1. Distribution of Characteristic of the Respondents
Variable N=60
Occupation
Working 28(46.7%)
Non Working 32(53.3%)
Education
Never 0(0.0%)
Graduate Elementary School 4(6.7%) Graduate High School 43(71.7%) Higher Education 13(21.7%)
Married Status
Unmarried 30(50.0%)
Married 21(35.0%)
Cohabitant 0(0.0%)
Divorced 0(0.0%)
Widow 9(15.0%)
Widower 0(0.0%)
Sex
Male 30(50.0%)
Female 30(50.0%)
Table 2. Quality of Life of Women of Reproductive Age with HIV Infection
Variable Very Good Good Poor
Physical Health 1(3.3%) 17(56.7%) 12(40.0%)
Psychological Health 1(3.3%) 19(63.3%) 10(33.3%)
Level of Independence 2(6.7%) 20(66.7%) 8(26.7%)
Social Relations 5(16.7%) 21(70.0%) 4(13.3%)
Environment 2(6.7%) 17(56.7%) 11(36.7%)
Spirituality 1(3.3%) 17(56.7%) 12(40.0%)
General health 15(50.0%) 13(43.3%) 2(6.7%)
Total Quality of Life 1(3.3%) 19(63.3%) 10(33.3%)
Table 3. Quality of Life of Men of Reproductive Age with HIV Infection
Variable Very Good Good Poor
Physical Health 0(0.0%) 15(50.0%) 15(50.0%)
Psychological Health 6(20.0%) 18(60.0%) 6(20.0%)
Level of Independence 7(23.3%) 18(60.0%) 5(16.7%)
Social Relations 9(30.0%) 20(66.7%) 1(3.3%)
Environment 4(13.3%) 21(70.0%) 5(16.7%)
Spirituality 3(10.0%) 15(50.0%) 12(40.0%)
General health 16(53.3%) 13(43.3%) 1(3.3%)
Total Quality of Life 2(6.7%) 26(86.7%) 2(6.7%)
Table 4. Difference of Quality of Life between Men and Women of Reproductive Age with HIV Infection
Variable
Groups
P value
Men Women
N=30 N=30
Physical Health
Very Good 0(0.0%) 1(3.3%)
Good 15(50.0%) 17(56.7%) 0.998
Poor 15(50.0%) 12(40.0%)
Psychological Health
Very Good 6(20.0%) 1(3.3%)
Good 18(60.0%) 19(63.3%) 0.799
Poor 6(20.0%) 10(33.3%)
Level of Independence
Very Good 7(23.3%) 2(6.7%)
Good 18(60.0%) 20(66.7%) 0.799
Poor 5(16.7%) 8(26.7%)
Social Relations
Very Good 9(30.0%) 5(16.7%)
Good 20(66.7%) 21(70.0%) 0.952
Poor 1(3.3%) 4(13.3%)
Environment
Very Good 4(13.3%) 2(6.7%)
Good 21(70.0%) 17(56.7%) 0.586
Poor 5(16.7%) 11(36.7%)
Spirituality
Very Good 3(10.0%) 1(3.3%)
Good 15(50.0%) 17(56.7%) 1.000
Poor 12(40.0%) 12(40.0%)
General Health
Very Good 16(53.3%) 15(50.0%)
Good 13(43.3%) 13(43.3%) 1.000
Poor 1(3.3%) 2(6.7%)
Total Quality of Life
Very Good 2(6.7%) 1(3.3%)
Good 26(86.7%) 19(63.3%) 0.236
Poor 2(6.7%) 10(33.3%)
DISCUSSION
The percentage of quality of life between men and women of reproductive age with HIV infection shows a difference. Women have a higher percentage in 5 domains in the good category (physical health, psychological, level of independence, social relations and spirituality), while men only have higher percentage in 2 domains (environmental and general health) with good and very good categories, although statistically different in percentage but statistically not significant. The results of this study are in line with study conducted by Fekete, et al. (2016) which stated that in general there were no differences in the quality of life between men and women of reproductive age. This study finding also as answer hopes for responses that arise when a person reveals HIV status which is associated with the increased concerns on poor health and sexual function. In addition, Handayani (2017) confirmed that there was no significant relationship between sex and age on the quality of life of PLWHA.
The absence of differences in quality of life was expected because as many as 66.7 %% of women respondents were married. This means that psychologically they have more support from families as an encouragement following the treatment for survival for the sake of the children.
Family support is significantly related to quality of life, a study conducted by Simboh et al. (2015) showed that a person with HIV/AIDS who received family support had a 61.1 times greater chance of obtaining a good quality of life. Most women respondents in the group did not work and had a low educational status, but because they lived in urban environments so that the power of decision making ability better. A demographic and health survey in Ethiopia conducted in 2005 showed the power of decision making by women is relatively better in urban areas than in rural areas.
Opportunistic infections were associated with lower mental health, as many as 63.3%
respondents did not experience symptoms of infection so as many as 76.7% felt themselves healthy. This indicates the better or equal quality of life between men and women. This is also supported by respondents adherence in taking ARV therapy to promote of good quality of life. The same age range of respondents in early adulthood, is also presumed to be the cause of the absence of differences in quality of life because at this time respondents were emotionally mature to deal with emotional
behavior and change life style patterns. They were able to increase life expectancy and set of values that can increase self-awareness positively. Based on the findings that there is no difference of quality of life, there is no difference the long-term management services for people with HIV/AIDS.
CONCLUSION Particular conclusion:
1. The quality of life of reproductive age women with HIV infection in the very good category was 1 person (3.3%), the good category were 19 people (63.3%), and 10 people were poor (33.3%).
2. The quality of life of reproductive age men with HIV infection in the very good category were 2 people (6.7%), the good category were 26 people (86.7%), and 2 respondents (6.7%) were poor.
General Conclusions
There is no difference in quality of life between men and women of reproductive age with HIV infection in terms of physical health, psychological health, level of independence, social relations, environment, spirituality, and general health between men and women of reproductive age with HIV infection.
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