Factors Associated with Quality of Life among Women Living with HIV in Bali

Putu Dian Prima Kusuma Dewi (1), Putu Sukma Megaputri (2), Ni Made Karlina Sumiari Tangkas (3)
(1) Sekolah Tinggi Ilmu Kesehatan Buleleng, Bali, Indonesia
(2) Sekolah Tinggi Ilmu Kesehatan Buleleng, Bali, Indonesia
(3) Sekolah Tinggi Ilmu Kesehatan Buleleng, Bali, Indonesia
Fulltext View | Download
How to cite :
Kusuma Dewi, P. D. P., Megaputri, P. S., & Tangkas, N. M. K. S. (2026). Factors Associated with Quality of Life among Women Living with HIV in Bali. Journal of Public Health and Pharmacy, 6(3), 508–519. https://doi.org/10.56338/jphp.v6i3.9474

Introduction: Women living with HIV (WLHIV) face greater social, economic, and psychological burdens than men, which directly affect their quality of life. This study aimed to examine factors associated with quality of life among women living with HIV receiving antiretroviral therapy (ART) in Bali, Indonesia.


Methods: This quantitative cross-sectional study included 197 women receiving ART in Jembrana and Gianyar districts, Bali. Data were collected through structured interviews using the WHOQOL-HIV BREF questionnaire and analyzed using ordinal logistic regression (ologit) in Stata 17. Quality of life (QoL) was categorized as high, moderate, or low.


Results: Most respondents (90.4%) had low quality of life. Factors significantly associated with quality of life included educational attainment (β = −0.958, AOR = 0.38, 95% CI: 0.20–0.74, p = 0.005), employment status (β = −1.37, AOR = 0.25, 95% CI: 0.06–0.94, p = 0.040), medication adherence support (β = 0.39, AOR = 1.48, 95% CI: 1.01–2.17, p = 0.040), and a history of forgetting antiretroviral medication (β = 4.61, AOR = 100.76, 95% CI: 6.31–1610.08, p = 0.001). Lower educational attainment and unemployment were associated with poorer quality of life, whereas treatment adherence and medication adherence support were associated with better well-being among women living with HIV.


Conclusion: A holistic approach integrating medical, psychosocial, and family support may help improve quality of life among women living with HIV and support adaptation to chronic illness. Promotive and preventive interventions should focus on strengthening family and peer support, expanding health education, and addressing social stigma to help women living with HIV maintain optimal QoL.

  1. UNAIDS. Unaids Data 2024 [Internet]. Unaids. 2024. Available from: https://www.unaids.org/en/resources/documents/2024/2024_unaids_data
  2. Charles-Eromosele TO, Kanma-Okafor OJ, Sekoni AO, Olopade BO, Olopade OB, Ekanem EE. Gender disparities in the socio-economic burden of HIV/AIDS among patients receiving care in an HIV clinic in Lagos, Nigeria. Afr Health Sci. 2022;22(4):477–487. https://doi.org/10.4314/ahs.v22i4.54
  3. UNAIDS. Ending Inequality, Ending AIDS. Global AIDS Strategy 2021–2026. United Nations AIDS [Internet]. 2023; Available from: https://www.unaids.org/en/resources/documents/2021/global-aids-strategy-2021-2026
  4. Waldron EM, Burnett-zeigler I, Wee V, Ng YW, Koenig LJ, Pederson AB, et al. Mental Health in Women Living With HIV: The Unique and Unmet Needs. J Int Assoc Provid AIDS Care. 2021; 20:1–18. https://doi.org/10.1177/2325958220985665
  5. Liu K, Cheng F, Dong H, Dong X, Xu J. Sexual orientation and quality of life of people living with HIV/AIDS in China: evidence from an institutional-based cross-sectional study. Qual Life Res. 2022; 31(1):125–34. https://doi.org/10.1007/s11136-021-02877-3
  6. WHO. Supporting re-engagement in HIV treatment services. 2023. 1–31 p. Available from: https://www.who.int/publications/i/item/9789240088243
  7. Ebrahimi H, Shoorideh FA, Sohrabi MR, Ebrahimi M, Hosseini M. An Analysis of Approaches to Reduction of HIV Stigma across the World through educational interventions: A Scoping Review. Investig y Educ en Enferm. 2024;42(1). https://doi.org/10.17533/udea.iee.v42n1e06
  8. Mahamboro DB, Fauk NK, Ward PR, Merry MS, Siri TA, Mwanri L. HIV Stigma and Moral Judgement: Qualitative Exploration of the Experiences of HIV Stigma and Discrimination among Married Men Living with HIV in Yogyakarta. Int J Environ Res Public Health. 2020; 17:1–15. https://doi.org/10.3390/ijerph17020636
  9. Dewi PDPK, Megaputri PS, Dwijayanti LA, Ayu D, Indra P, Dewi MJ. Mortality Of HIV/AIDS-Infected People with Antiretroviral Therapy: A Gender Analysis. Belitung Nurs J. 2018;4(6):559–65. https://doi.org/10.33546/bnj.571
  10. Lisnawati Lubis, Sori Muda Sarumpaet I. Correlation of Stigma, Depression And Fatigue With Quality Of Life Among HIV / AIDS Patients in Klinik Veteran Medan). Idea Nurs J. 2016; VII (1):1–12. https://doi.org/10.52199/inj.v7i1.6460
  11. Dian P, Kusuma P, Megaputri PS, Ketut N, Wulandari A, Dianiati LA, et al. Sex and Functional Status as a Predictor of Death of People Living With HIV/AIDS On ARV Therapy In Buleleng Hospital. Indonesian Journal of Nursing and Midwifery. 2020;8(2):116-122. https://doi.org/10.21927/jnki.2020.8(2).116-122
  12. Dewi PDPK, Agung A, Sawitri S, Putu L, Wulandari L, Putra IWGAE, et al. Sex and Partner Status as Predictors of Loss to Follow Up Among HIV/AIDS Patients on ARV Treatment in Badung District Hospital, Bali 2006 - 2014. In: Asia Pacific AIDS Conference Proceedings. 2015.Available from: https://na.eventscloud.com/file_uploads/95598de5a0b00f4eb8f3ba4dc9af37a8_DianPrima.pdf
  13. Dewi PDPK, Widiarta GB. Predictors of Mortality among Patients Lost to Follow up Antiretroviral Therapy. J Ners. 2018;13(1). https://doi.org/10.20473/jn.v13i1.6568
  14. Sitorus RJ, Novrikasari N, Syakurah RA, Natalia M. Efek Samping Terapi Antiretroviral dan Kepatuhan Berobat Penderita HIV/AIDS. J Kesehat. 2021;12(3):389. https://doi.org/10.26630/jk.v12i3.2869
  15. Hikmah SM, Kuswiharyanti H, Raafi VA, Juarti N, Amaliadiana T. Pengaruh Terapi ARV untuk Meningkatkan Kualitas Hidup Pasien HIV/AIDS: A Literature Review. J Bionursing. 2021;3(2):134–45. https://doi.org/10.20884/1.bion.2021.3.2.101
  16. Rokhani M. Quality of Life for People Living with HIV/AIDS After 10 Years of Living with the Virus. Pros Semin Nas Unimus. 2018; 1:58–63. Available from: https://prosiding.unimus.ac.id/index.php/semnas/article/view/30
  17. Rosnaini, Gobel FA, Multazam A. Hubungan Dukungan Sosial dengan Kualitas Hidup ODHIV di Yayasan Peduli Kelompok Dukungan Sebaya Makassar. Wind Public Heal J. 2021;01(05):453–63. https://doi.org/10.33096/woph.v2i1.117
  18. WHO. WHO guideline on HIV service delivery. 2025. 1–56 p. Available from: https://www.who.int/publications/i/item/9789240105049
  19. Skevington SM, Lotfy M, O'Connell KA. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. Qual Life Res. 2004;13(2):299-310. https://doi.org/10.1023/B:QURE.0000018486.91360.00
  20. Mutabazi-mwesigire D, Katamba A, Martin F, Seeley J. Factors That Affect Quality of Life among People Living with HIV Attending an Urban Clinic in Uganda: A Cohort Study. PLoS One. 2015;10(6): e0126810. https://doi.org/10.1371/journal.pone.0126810
  21. Manyara AM, Manyanga T, Burton A, Wilson H, Chipanga J, Bandason T, et al. Prevalence, factors and quality of life associated with frailty and pre-frailty in middle-aged and older adults living with HIV in Zimbabwe: A cross-sectional study. HIV Med. 2025;26(1):153–65. https://doi.org/10.1111/hiv.13716
  22. Shriharsha C, Rentala S. Quality of life among people living with HIV / AIDS and its predictors : A cross ‑ sectional study at ART center, Bagalkot, Karnataka. J Family Med Prim Care. 2019;8(3):1011–1016. https://doi.org/10.4103/jfmpc.jfmpc_411_18
  23. Sendaula E, Buwembo M, Opio D. Clinical profile of HIV-infected adults receiving a holistic approach of care model in Nakawa, Kampala District. PLoS One. 2022;17(7 July):1–8. https://doi.org/10.1371/journal.pone.0272039
  24. Girma D, Abita Z, Agegnehu W, Asmelash D, Adugna A, Shifera N, et al. Predictors of anemia among HIV- infected children in Ethiopia: systematic review and meta- analysis. Sci Rep. 2025; 15:5968. https://doi.org/10.1038/s41598-025-85285-8
  25. Shrivastav V, Yogesh M, Ramachandran A, Makwana N, Parmar D. Prevalence and risk factors of anemia among people living with HIV/AIDS in Southeast Asia: a systematic review and meta-analysis. BMC Infect Dis. 2025; 25:550. https://doi.org/10.1186/s12879-025-10941-3
  26. Li X, Qiao S, Yang X, Harrison SE, Tam CC, Shen Z, et al. A Resilience-Based Intervention to Mitigate the Effect of HIV-Related Stigma: Protocol for a Stepped Wedge Cluster Randomized Trial. Front Public Health. 2022;10(March):1–13. https://doi.org/10.3389/fpubh.2022.857635
  27. Kanters S, Renaud F, Rangaraj A, Zhang K, Limbrick-Oldfield E, Hughes M, et al. Evidence synthesis evaluating body weight gain among people treating HIV with antiretroviral therapy - a systematic literature review and network meta-analysis. eClinicalMedicine. 2022; 48:1–12. https://doi.org/10.1016/j.eclinm.2022.101412
  28. Ayale Y, Mph F, Zeleke AM, Assefa GW, Kegne G, Mph N, et al. Systematic Reviews Depression and associated factors among human immunode fi ciency virus-positive pregnant women in sub-Saharan Africa: systematic review. AJOG Glob Reports. 2025;5(2):100475. https://doi.org/10.1016/j.xagr.2025.100475
  29. Farhanidiah S, Nursalam N, Triharini M, Efendi F, Tristiana RD, Priyantini D, et al. Relationship between stigma and health-related quality of life among people living with HIV. HIV AIDS Rev. 2025;24(2):136–41. https://doi.org/10.5114/hivar/155257
  30. Beichler H, Grabovac I, Dorner TE. Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS. Int J Environ Res Public Health. 2023;20(4). https://doi.org/10.3390/ijerph20043374
  31. Panayi M, Charalambous GK, Jelastopulu E. Enhancing quality of life and medication adherence for people living with HIV: the impact of an information system. J Patient-Reported Outcomes. 2024;8(1). https://doi.org/10.1186/s41687-023-00680-x
  32. Audina PW, Tobing DH. Self-Acceptance amongst People Living with HIV/AIDS: A Literature Review. Humanit (Jurnal Psikologi). 2023;7(2):195–212. https://doi.org/10.28932/humanitas.v7i2.6722
  33. Chinyandura C, Jiyane A, Tsalong X, Struthers HE, Mcintyre JA, Rees K. Supporting retention in HIV care through a holistic, patient-centred approach: a qualitative evaluation. BMC Psychol. 2022; 10:17. https://doi.org/10.1186/s40359-022-00722-x
  34. George S, Bergin C, Clarke S, Courtney G, Codd MB. Health-related quality of life and associated factors in people with HIV: An Irish cohort study. Health Qual Life Outcomes. 2016;14(1):1–12. https://doi.org/10.1186/s12955-016-0517-4
  35. Monasel AH, Susanto HS, Yuliawati S, Sutiningsih D. Factors Associated with Quality of Life Among People Living with HIV/AIDS (PLHIV) at the Sehat Peduli Kasih Foundation, Semarang City. J Epidemiol Kesehat Komun. 2022;7(1):444-457. https://doi.org/10.14710/jekk.v7i1.9904
  36. Solehah EL, Peristiowati Y, Puspitasari Y. Efforts to Improve the Quality of Life of People Living with HIV through a Hospice Care Programme in Buleleng Sub-district. J Keperawatan Muhammadiyah. 2023;8(4). https://doi.org/10.30651/jkm.v8i4.20301
  37. Mi T, Zhou G, Li X, Qiao S, Yang X, Shen Z, et al. The association between HIV disclosure to family members and quality of life among people living with HIV/AIDS: The indirect effects through social support. Curr Psychol. 2021;42(7):5755–64. https://doi.org/10.1007/s12144-021-01927-w
  38. Goodrum NM, Masyn KE, Armistead LP, Avina I, Schulte M, Marelich W, et al. A Mixed-Methods Longitudinal Investigation of Mothers’ Disclosure of HIV to Their Children. Child Dev. 2021;92(4):1403–20. https://doi.org/10.1111/cdev.13493
  39. Lejone TI, Kopo M, Bachmann N, Brown JA, Glass TR, Muhairwe J, et al. PEBRA trial - Effect of a peer-educator coordinated preference-based ART service delivery model on viral suppression among adolescents and young adults living with HIV: Protocol of a cluster-randomized clinical trial in rural Lesotho. BMC Public Health. 2020;20(1):1–9. https://doi.org/10.1186/s12889-020-08534-y
  40. Rani AH, Budiyati D, Farizal RR, Purwati NH, Nursanti I. Electronic Medication Event Monitoring System (MEMS) Based on Monitoring by Electronic to Improve Adherence to Antiretroviral Therapy in Children with HIV/AIDS Infection: A Systematic Review. An Idea Health Journal. 2025;5(1):66–79. https://doi.org/10.53690/ihj.v5i01.229
  41. Darlis I, Gobel FA, Arman, Talosig A, Komariah ED. The Influence of the Information Motivation Behavioral Skills Model Approach on Increasing HIV/AIDS Prevention Information. Window of Health: Jurnal Kesehatan. 2024;7(4):383–391. https://doi.org/10.33096/woh.v7i4.417
  42. Okonji EF, Wyk B Van, Hughes GD, Mukumbang FC. Implementation of a Psychosocial Support Intervention for Adolescents on Antiretroviral Treatment: Challenges and Experiences from Ehlanzeni District, South Africa. J Int Assoc Provid AIDS Care. 2022; 21:1–10. https://doi.org/10.1177/23259582221121094
  43. Indonesia Positif Network. Indeks Stigma terhadap Orang yang Hidup dengan HIV Edisi ke-2 di Indonesia. Jakarta; 2024. Available from: https://jip.or.id/people-living-with-hiv-stigma-index-2-0-in-indonesia/
  44. Hidayat J, Huang XY, Lin HR, Wei SJ, Chen MY, Pranata S. Exploring the Experience of Stigma among People Living with HIV in Bali, Indonesia: A Qualitative Phenomenological Study. Makara J Health Res. 2022;26(1):44–50. https://doi.org/10.7454/msk.v26i1.1331
Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Authors who publish with Journal of Public Health and Pharmacy retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:

  1. Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.

  2. Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Journal of Public Health and Pharmacy.

  3. License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.

Downloads

Download data is not yet available.