Social exclusion and health-related quality of life of people living with HIV during COVID-19 pandemic

BACKGROUND: The challenges that COVID-19 has brought can lead to an increase in the PLHIV social exclusion risk, which could impair their health-related quality of life (HRQoL). This study aimed: 1) to know the degree of social exclusion that PLHIV suffered in Spain and the most impaired dimensions;2) to analyze the effect of social exclusion on PLHIV''s HRQoL; 3) to study the evolution of PLHIVs' social exclusion and HRQoL during COVID-19 times.
METHODS: We conducted two nested studies. A total of 515 PLHIV participated in a cross-sectional study conducted between October-December. A short-longitudinal study was conducted in a sub-sample of 135 PLHIV who six months before filled the questionnaire measuring the study variables. Eleven Spanish HIV centers (clinics and NGOs) recruited the participants and collected the data through an online self-administered survey. We used the Index of Social Exclusion for Health Surveys to measure social exclusion and the WHOQOL-HIV-BREF to measure HRQoL.
RESULTS: Most of the participants of the overall sample were men (74%). Their mean age was of men composed the total sample. The mean age was 43.36"±11.05 years. The cross-sectional study's results with the largest sample (n=515) showed that 35.1% suffered moderate-to-strong social exclusion. Material deprivation and social participation were the dimensions most affected (30.7 and 28.9% of PLHIV showing moderate-to-strong scores, respectively). Compared with men, women presented a higher social exclusion score (p=.015), mainly in the material deprivation dimension (p<.001). Cross-sectional results showed high negative correlations between social exclusion and all HRQoL domains (p<.001). Longitudinal results showed an increase in the percentage of PLHIV suffering social exclusion to some degree (p<.001). The dimension most impaired was material deprivation because we found 4% more of participants moved to the moderate-to-strong category. The social exclusion dimension related to social participation predicted negatively the six month later Psychological health and Social relationships HRQoL dimensions (p=.021, p<.001).
CONCLUSIONS: The present study is the first to assess the social exclusion of PLHIV in Spain. It seems to be a relevant problem in Spain. In six months between COVID-19 outbreaks PLHIV's social exclusion evolved negatively and undermined PLHIV's HRQoL.