A Social Ecological Approach to Understanding Life Satisfaction Among People Living with HIV/AIDS in Taiwan

Background and purpose: Publicly-funded medication is offered for all people living with HIV/AIDS (PLWHA) in Taiwan, which poises this population to manage HIV as a chronic condition. Life satisfaction, defining as “contentment, harmony, happiness, or optimism about one’s life and health” (Buseh et al., 2006, p. 37), has become an important goal and plays a salient role in maintaining PLWHA’s health through improving immune functioning and medication adherence. Studies suggest socio-cultural differences in multi-level (health, individual, social, and structural) factors which influence life satisfaction.  Thus, for social workers to implement contextually-relevant interventions, it is important to conduct life satisfaction research in understudied contexts, such as Taiwan. Utilizing a social ecological framework, the purpose of this study was to understand multi-level (health, individual, social, and structural) influences on life satisfaction among PLWHA in Taiwan.

Methods: A cross-sectional survey was implemented with PLWHA recruited from community-based organizations (i.e.HIV and substance use specific) and local prisons in both urban North and rural South of Taiwan.  An MSW-level research assistant administered a 30 minute survey focused on socio-demographics and key social ecological factors, including: health (CD4 count), individual (medication adherence, AIDS knowledge, empowerment), social (HIV community participation), and structural (HIV-related stigma) factors. The outcome variable, life satisfaction, was measured using a reliable and valid standardized measure, the Satisfaction with Life Scale (Diener, Emmons, Larsen & Griffon, 1985).  Descriptive analyses were conducted among variables to calculate frequencies, means and standard deviations (SD). Bivariate correlations were computed to examine the relationship between all of the measures.  A hierarchical multiple regression analysis was conducted to assess the effects of health, individual, social and structural factors on life satisfaction.

Results: Three hundred and seventy-nine PLWHA in Taiwan completed the questionnaire. The majority of participants were male (76.1%), were MSM (47.6%) or IDU (47.3%), had low income (79.9%) and had less than high school education (66.7%).  Most lived in the north of Taiwan (62.7%), lived in community versus prison (69.5%), and had relatively good health indicated by higher CD4 counts (63.6%). Sociodemographic factors had a small but significant effect, explaining 7.6% of the variance in life satisfaction F(9,326)=4.05,p<.001).  After adjusting for sociodemographic variables, health, individual, social, and structural factors accounted for 34.5% of the variance in explaining life satisfaction (F(15, 320)=12.77,p<.001).  Higher empowerment (β=0.23,p<.001) and HIV community participation (β=0.13,p<.05) scores were significantly associated with greater life satisfaction. A lower HIV-related stigma score was associated with greater life satisfaction (β=-0.08,p<.001).

Conclusions and Implications: Our findings support a social ecological approach to understanding life satisfaction among PLWHA in Taiwan.  With the potential to increase life satisfaction among this population, empowerment-oriented social work interventions and encouraging active engagement in the HIV community can be utilized to increase life satisfaction among PLWHA. Importantly, social workers should continue efforts to address HIV-related stigma at individual, organizational, and societal levels to fight for justice and improve life satisfaction among this population. Social and behavioral research among PLWHA in diverse cultural settings may facilitate service providers in applying a social ecological approach in working with PLWHA.