
 aids is a fatal disease that can affect human immune system and makes patients vulnerable to opportunistic infections .
it is still one of the most important diseases in the world , which not only causes health problems , but also affects the political , social , and cultural aspects ( 1 ) . 
 

the use of effective anti - viral therapy in the patients with delayed onset of aids and the increase of life expectancy and well - being of hiv - infected individuals reveal the need for effective prevention methods in this population ( 2 ) .
advances improved the survival rates of the hiv - infected individuals , but not always with a good quality of life ( qol ) ( 3 ) .
various studies conducted around the world have reported that as the hiv infection progresses , it affects the individuals ' qol ( 4 - 6 ) . 
 

according to the latest report by iran 's ministry of health , by the end of february 2013 , 26125 people will be identified with hiv in iran .
overall , the disease was transmitted by intravenous drug injection , sexual intercourse , and mother to child in 52.1% , 33.6% , and 3.2% of the cases , respectively .
however , the transmission route is unknown in 11.1% of the patients ( 7 ) . 
 
 in iran ,
the first wave of aids occurred in 1987 due to transmission of agent is through 
 blood as well as blood products and its second wave occurred in 1996 - 1997 because of intravenous drug abusers sharing needles .
now , at the third wave of aids , is through sexual relationships because of perversion which threatens several parts of the society ( 8) .
health - related quality of life ( hrqol ) outcomes are of importance in study of persons with the relapsing and remitting disease and the need to evaluate effects of newer treatments on improving their health status ( 9 ) . 
 

moreover , effective anti - viral medication have delayed the onset of aids cycle and increased the patients life time .
nevertheless , from the psychological perspective , aids patients are faced with a large number of social and cultural limitations which affect different dimensions of their health and quality of life . in general , quality of life
is defined as the individuals understanding of their life status in cultural as well as value systems fields , which is related to their goals , hopes , and standards .
thus , quality of life can be considered as the sum of physical , mental , and social welfare , including happiness , satisfaction , dignity , health , and economic status , perceived by the individuals ( 10 ) . meanwhile
, the people s qol is affected by various factors , such as individual , economic , and social factors ( sex , age , employment , marital status , etc . ) , with stronger effects on those suffering from chronic disease . 
 

therefore , the present study aims to investigate the qol based on some individual factors , such as age , sex , history of drug abuse , employment status , length of disease , marital status , transmission route , and the distance between the house and the service providers , in hiv - positive patients of shiraz behavioral counseling center , iran . 


 the present study was a cross - sectional type in which the hiv - positive patients of shiraz behavioral counseling center with active profile were examined . according to the previous studies and the sample size formula ,
the study data were collected through 2 questionnaires , the first included the demographic information , such as age , sex , marital status , employment status , length of disease , level of education , history of drug abuse , and the distance between the house and the service providing center .
the second questionnaire was sf-36 , which is a 36-item self administered or interviewer - administered instrument with eight scales : physical functioning , role limitations caused by physical health problems , pain , general health perceptions , emotional well - being , role limitation caused by emotional problems , social functioning , and energy / fatigue .
reliability estimates for these eight scales was favorable in both general population and chronic diseases samples ( 11 - 19 ) .
a survey conducted in iran confirmed that , the persian version of this questionnaire was a reliable and valid instrument ( 20 ) . though the sf-36 has eight separate scales , factor analyses in previous studies have shown that these scales represent two underlying dimensions : physical and mental healths ( 16 , 21 and 22 ) . 
 
 according to rand scoring system ,
the items of the questionnaire are scored from 0 to 100 ; and the closer to 100 , indicates higher qol .
moreover , chi - square , t - test , and anova were used to determine the relationship between the variables and mean differences , and , p<0.05 considered statistically significant . 


 according to rand scoring system , the items of the questionnaire are scored from 0 to 100 ; and the closer to 100 , indicates higher qol .
moreover , chi - square , t - test , and anova were used to determine the relationship between the variables and mean differences , and , p<0.05 considered statistically significant . 


 of the 129 patients studied , 115 ( 89.8% ) were male and 13 ( 10.2% ) female .
the patients age ranged of 25 - 58 years ( mean + sd= 38.9 + 6.7 ) .
in addition , the mean age of the male and female subjects were 39.3 + 6.8 and 35.2 + 4.5 years , respectively and the highest frequency related to 35 - 44 years age group . 
 
 in this study , 77 ( 61.1% ) , 26 ( 20.6% ) , and 23 ( 18.3% ) patients
in addition , 27 patients ( 21.3% ) employed , while 99 ( 78.7% ) were unemployed .
finally , 85.2% of the patients had a history of drug abuse , while 14.8% did not .
76 ( 61.8% ) , 26 ( 21.1% ) and 21(17.1% ) of the patients were infected through needle use , sexual and other route of transmission , respectively . 
 

the overall hrqol score in these patients was 48.8 + 17 , and the mean for qol in physical and mental dimensions were 50.4 + 18.9 and 46.3 + 17.8 , respectively with a statistically significant base on difference(p<0.05 ) .
the mean scores of the patients qol in each of the scales of sf-36 questionnaire are presented in table 1 . 
 

the difference between different age groups mean scores quality of life was not statistically significant ( p>0.05 ) . 
 

investigation of the patients qol with regard to sex , employment status , history of drug abuse , age , level of education , length of disease , and the distance between the house and the service providing center revealed that this parameter for , female , employed , and non - addicted patients was significantly higher than that of the male , unemployed , and addicted ones , respectively ( p<0.05 ) .
however , no significant relationship was found between the qol and age , level of education , length of disease , and the distance between the house and the service providing center ( p>0.05 ) . 
 

finally , after obtaining significant results in anova regarding marital status and transmission routes , the schiff 's post hoc test was used to determine the significant difference of qol in different levels of the above - mentioned variables .
the results revealed significant relationships between married , single , and other groups of patients as well as intravenous drug abuse and other transmission routes ( p<0.05)(table 3 ) . 


 the present study aimed to investigate the qol and its related factors in hiv patients of shiraz behavioral counseling center . in this study , the patients mean score of qol was 48.8 + 17 which was comparable with the study done by nojoumi et al .
reported the mean score of quality of life as 47 + 6.2 ( 23 ) .
moreover , the mean scores of physical and mental dimensions were 50.4 + 18.9 and 46.3 + 17.8 , respectively that was consistent with a great number of studies conducted in other countries , including imam s study in bangladesh and hay in the u.s . , as well as those performed in iran which have all revealed the
hiv patients low qol in all the dimensions of sf-36 questionnaire , particularly in mental and social dimensions , compared to normal individuals and even those with chronic diseases ( 10 , 24 - 29 ) . 
 

in fact , biological treatments are not enough for treating such patients and , at the same time , getting familiar with and eliminating their mental problems can be a good prognosis for their treatment . 
 

investigation of mean differences of qol relative to different levels of the variables revealed that women had a higher qol in comparison to men .
moreover , the hiv infection was mostly transmitted through intravenous drug abuse ( 61.8% ) and sexual route ( 21.1% ) . nevertheless , in comparison to the individuals infected through sexual relationships , those who infected by intravenous drug abuse had a lower qol .
this is in contrast with the findings of the study conducted by hasanah in malaysia which reported a higher qol for the individuals who had been infected through intravenous drug abuse compared to those through sexual relationships ( 27 ) . 
 
 according to the study findings , qol of married subjects was significantly higher than that of the other participants , which might be due to the families and particularly the spouse s psychological supports which play a major role in improving the patients qol .
employed subjects had also a better qol compared to the jobless ones . in the studies conducted by nojomi in iran and eriksson in sweden , a significant relationship was found between the quality of life and sex , marital , and employment status which are in line with the findings of the present study ( 23,30 ) . 


 application of the results in this study showed that the effects of different factors on the qol .
interventions , including resource allocation , better care for the patients , improving the relationship between the physicians and the patients , and increasing the trainings as well as consultations , can all be carried out . 
 
 creating appropriate job opportunities and employing the patients by the health system as well as the behavioral counseling centers are among the major supportive measures for these patients .
in fact , employment are the most important concerns of such patients ; therefore , a large number of financial and , consequently , psychological problems of the patients could be resolved by providing job opportunities . finally , it is hoped that using the findings of this research , steps will be taken toward improving the hiv patients qol . 

 
 background : hiv / aids is known to affect an individual not only physically but also mentally , socially , and financially . 
 it is a syndrome that builds a vacuum in a person affecting his / her life as a whole . 
 nowadays , using anti - viral medication delays the onset of the disease cycle and increases the patients life time . from the psychological point of view 
 , however , such patients are faced with a great number of social and cultural limitations which affect various dimensions of their health as well as quality of life . 
 therefore , the present study aimed to investigate the quality of life and its related factors in hiv patients in shiraz behavioral counseling center . 

 
 methods : the present analytical cross - sectional study was conducted on 129 hiv patients in shiraz behavioral counseling center who were selected through convenience sampling . 
 the data were gathered using demographic as well as sf-36 questionnaires and analyzed through t - test , anova , x2 , and schiff 's post hoc test . 

 
 results : in this study , the patients mean score of quality of life was 48.8 + 14 . in addition , the mean scores of males and females life quality were 47.7 + 16.2 and 59.5 + 20.4 , respectively and the difference was statistically significant ( p<0.05 ) . 
 the mean difference of the patients quality of life was also found to be significant based on employment status , marital status , and history of drug abuse ( p<0.05 ) , while it was not significant regardin gage , level of education , length of disease , and the distance between the house and the service providing center . 

 
 conclusion : in comparison to the physical dimension , the hiv - positive individuals quality of life mean score was lower in the mental dimension . 
 in addition , the mean difference revealed to be significant based on marital as well as employment status . 
 these findings show such patients needs for psychological support , more psychological interventions , and creation of appropriate job opportunities . 
 