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Living well means something different to every person

While diagnosis, access to ART and viral suppression remain cornerstones of the World Health Organisation's 90-90-90 target* to end the AIDS epidemic, it is also now widely recognised that PLHIV should not merely survive with their condition but thrive with it.

Today, many of us involved in HIV care are united under a common goal – to help PLHIV achieve a good QoL – also known as the ‘fourth 90'.

To do this, we need to recognise that good QoL is in the eye of the beholder: no one outcome can fit every individual need of a person living with HIV.

Thinking about the key facets of QoL in HIV

QoL is a multi-faceted and complex measure – defined as an all-encompassing phrase for “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.”[1]

As such, QoL can be impacted by an intricate combination of physical, mental, social and environmental factors that make up a person’s everyday life.

Determining QoL is not easy, and this is especially true for PLHIV. They experience depression, anxiety and pain more often than the general population.[2][3]

They are more likely to abuse substances[4] and more commonly face stigma.[5]

However, by asking the right questions, HCPs can work with their patients to determine the facets of QoL that matter to them.

4 key domains that impact Quality of Life in HIV

The Health Goals for Me framework

The Moving Fourth Steering Committee recognise that the key to achieving better QoL with HIV is focusing on the individual health goals of patients.

To support this, the Steering Committee designed the Health Goals for Me framework: a 3-step approach that facilitates HCPs and patients working together to mutually agree on individual objectives for care, and ultimately achieving healthy living with HIV beyond viral suppression.

ART: antiretroviral therapy; HCP: healthcare professional; PLHIV: people/person living with HIV; QoL: quality of life.

*Since the proposal of the Health Goals for Me framework, UNAIDs have announced an updated 95-95-95 target to help end the AIDS epidemic. Despite this update, the Moving Fourth Steering Committee believe improving QoL remains a key goal to achieve healthy living with HIV. As such, the framework should still be considered an important component of HIV care.

References

WHO. Health Statistics and information systems. WHOQOL: Measuring Quality of life. Available at: https://www.who.int/toolkits/whoqol (accessed January 2022).
Annemiek Schadé, et al. HIV-infected mental health patients: characteristics and comparison with HIV-infected patients from the general population and non-infected mental health patients. BMC Psychiatry. 2013; 13:35.
Maria Giulia Nanni, et al. Depression in HIV infected PLHIV: a Review. Curr Psychiatry Rep. 2015; 17:530. Available at: https://link.springer.com/article/10.1007/s11920-014-0530-4 (accessed January 2022).
Noe Garin, et al. Recreational drug use among individuals living with HIV in Europe: review of the prevalence, comparison with the general population and HIV guidelines recommendations. Front Microbiol. 2015; 6:690. Available at: https://www.frontiersin.org/articles/10.3389/fmicb.2015.00690/full (accessed January 2022).
Christiana Nöstlinger, et al. HIV-Related discrimination in European health care settings. AIDS Patient Care STDs. 2014; 28(3): 155-61.
CP-240129 - January 2022