INTRODUCTION:

Assess Human Immuno deficiency Virus (HIV) is a pervasive retrovirus that attacks the human immune system, disabling its proper function worldwide¹. HIV often develops into Acquired Immune Deficiency Syndrome (AIDS), which perpetuates a weakened immune system. This ultimately leads to a heightened vulnerability of contracting morbidities, including Cytomegalovirus retinitis, HIV-related encephalopathy, and Mycobacterium tuberculosis. These AIDS-defining conditions are life-threatening for patients of HIV/AIDS, ultimately diminishing their quality of life (QoL)². As a virus affecting the global population, HIV has permeated a seemingly small proportion of the Indian population: 0.29%. However, considering India’s population, this percentage is an alarming 2.1 million people, making it the world’s third most heavily HIV-affected country³. Therefore, it becomes imperative to combat the current epidemic, especially in these highly concentrated areas.³

Recently, combating the spread of HIV/AIDS has been primarily due to advances in the advent of antiretroviral therapy (ART). A non-curative treatment, ART is a medication that suppresses HIV replication, ultimately decreasing viral loads and increasing CD4 count⁴. When CD4—the white blood cells critical for the immune system—counts are increased, it helps lower the incidence of opportunistic infections in people living with HIV/AIDS (PLHIV). In fact, studies in recent years have consistently observed a dramatic reduction in HIV-related morbidity and mortality following ART use⁵. Effective ART requires adherence rates of 95% or higher. To support this, the Indian government has made ART medication available free of charge to those who need it. In India, public healthcare facilities, including medical colleges, district hospitals, and non-profit institutions, act as ART centers, thus allowing for greater accessibility.

Some areas have private healthcare organizations to provide additional assistance. One such organization is The Salvation Army (TSA) Catherine Booth Hospital and its Community Health Development Programme (TSA-CHDP), which has been providing comprehensive care for widows living with HIV/AIDS since 1992. Their pioneering efforts include introducing ART in collaboration with the Christian Medical College Hospital in Vellore, providing home-based care, identifying HIV-positive status among pregnant women at government-integrated centers for counseling, testing, and primary healthcare, and initiating outreach efforts. During the prenatal period, TSA-CHDP staff members administer regular medical check-ups, immunizations, and nutritious supplements. Such programs further optimize the efficiency and effectiveness of treatment and care programs for PLHIV. For this study, it is essential to note the efforts of TSA-CHDP, as all participants are drawn from the CHDP database. Disclosure of HIV status typically results in social isolation; hence, there is a limited number of known widows living with HIV. Through these records, a sample can be obtained.

MATERIAL AND METHODS:

This study employed a descriptive cross-sectional design to evaluate the quality of life (QoL) among HIV-positive widows residing in the Tirunelveli and Kanyakumari districts of Tamil Nadu, India. A mixed-methods approach was adopted, integrating both quantitative and qualitative data collection to gain a comprehensive understanding of the participants’ experiences. Participants were randomly selected from the CHDP registry, resulting in the inclusion of 110 widows in the study: 10 for a pilot study and 100 for the primary research, all of whom met the established inclusion criteria. Four data collection instruments were utilized: a demographic questionnaire, the Medical Adherence Assessment Questionnaire, the WHOQOL-HIV BREF instrument for QoL assessment, and a researcher-developed questionnaire addressing social network support. To accommodate participants with low literacy levels, questionnaires were translated into Tamil and administered through interviews by trained personnel. A pilot study conducted from July 24 to July 25, 2024, facilitated the refinement of the data collection tools, resulting in the selection of the WHOQOL-HIV BREF due to its relevance and the removal of a culturally insensitive question. Formal approval for the study was secured from the TSA-CHDP director, and informed consent was obtained from all participants involved. Data collection occurred from July 26 to August 5, 2024, with ten interviews conducted daily to ensure participant comfort. The primary focus of the study was on antiretroviral therapy (ART) adherence, QoL, and the impacts of external support. Prior to analysis, the collected data underwent a review process to ensure reliability.

RESULTS:

The data were analyzed and organized as follows:

Section 1: Description of baseline variables of the study subject.

Section 2: Medication Adherence Levels.

Section 3: Score distribution of WHOQOL-HIV.

BREF:

Section 4: Qualitative component of the study:

Section 1: Description of baseline variables of the study subject.

Table 1: Sociodemographic characteristics of the participants

(n = 100)

Demographic Variables	Category	n (%)
Age	20-29	0
	30-39	4
	40-49	56
	50-59	32
	60-69	8
Education	Primary School	38
	Middle School	33
	High School	17
	College	3
	No Education	9
Occupation	Unemployed	33
	Agriculture	15
	Non-Agriculture	27
	Daily Wage	25
Living with Family Status	Live with Relatives	87
Living with Family Status	Live Alone/ No relatives	13
Town/Location	Urban	36
Town/Location	Rural	64
Time since ART onset	Less than ten years	23
	10.1-20 years	70
	20.1-30 years	7
	Greater than 30 years	0
Monthly Income	Less than ₹5000	74
	₹5001 - ₹10,000	22
	Greater than ₹10,000	4
Route of Infection	Before Marriage	0
	After Marriage	97
	Blood Transfusion	3
	Drug Abuse	0
Have you disclosed the ART treatment status to family members?	Yes	86
	No	14
Support Group	Self Support	53
	Family	14
	Friends	3
	CHDP Social networks	26
	Positive Network	4

Table 1 depicts the sociodemographic information of all interviewed participants. Among the respondents, 56% were in the 40-49 age bracket, followed by 32% in the 50-59 age bracket. Most participants had less than a high school education, with 38% only studying until primary school and 9% having no education. 87% of participants lived with relatives, and 64% were settled in rural environments as opposed to the 36% urban minority. 70% of participants had 10-20 years of ART medication. 74% of participants receive a monthly income of less than ₹5000, where many reported being solely reliant on their widow’s pension of ₹1000 or their government-allotted ART pension of ₹1200. An overwhelming 97% of widows believed their route of infection came after marriage via their spouse. 86% of participants disclosed their ART treatment status to their family members. Concerning support, there were three main categories: self-support (53%), CHDP social networks (26%), and family (14%).

Section 2: Medication Adherence Levels

Figure 1: Percentage distribution of the sample according to Medication Adherence Levels

Figure 1 is representative of participant responses to the Medication Adherence Questionnaire. Of the 100 participants, 47 were classified in the good adherence category with a score of 8. 40 participants fell in the moderate adherence category, with a score of either 6 or 7. The remaining 13 individuals were categorized as having poor adherence, with a score of five or less. None of the participants scored less than three on her assessment. Often, the determining factor between good and moderate adherence was the first question, “Do you ever forget to take your medication?” If a respondent responded yes, they no longer qualified for the good adherence category and were sorted into the subsequent moderate classification.

Section 3: Score distribution of WHOQOL-HIV BREF

Table 2: Domain Summary n=100

Domain	Mean of Transformed scores	QoL Classification
1. Physical Health	58	Good
2. Psychological Health	49	Good
3. Level of Independence	44	Good
4. Social Relations	21	Moderate
5. Environment	78	Very Good
6. Spirituality	33	Moderate

Table 2 presents the score distribution for each domain on the WHOQOL-HIV BREF. The summary of all domain-transformed scores is as follows: Physical Health, 58; Psychological Health, 49; Level of Independence, 44; Social Relations, 21; Environment, 78; and Spirituality, 33. Each mean-transformed score corresponds to a QoL classification bracket: Poor, Moderate, Good, or Very Good. The study found that only the Environment domain fit into the highest “Very Good” bracket. On the other hand, Physical, Psychological, and Level of Independence were classified as “Good” categories. Both Social Relations and Spirituality were moderate, with scores of 21 and 33, respectively, indicating limited satisfaction in these domains.

Table 3: The Mean Scores, Median, and Standard Deviations of the 30 Questions (n=100)

	Mean	Median	SD
QoL
1. How would you rate your quality of life?	3.5	3	1.30
2. How satisfied are you with your health?	3.6	4	1.13
Domain: Physical Health
3. Pain and discomfort	2.65	3	1.41
4. Physical problems related to HIV	3.37	3	1.45
14. Energy in Daily Life	3.57	4	1.47
21. Satisfaction with Sleep	3.57	4	1.48
Domain: Psychological Health
6. Positive feelings	3.16	3	1.46
11. Concentration ability	4.43	5	0.97
15. Bodily image self-acceptance	4.03	5	1.40
24. Self-Satisfaction	3.47	4	1.46
30. Negative feelings	2.61	3	1.36
Level of Independence
5. Dependence on medication	3.92	5	1.44
20. Mobility	4.4	5	1.13
22. Activities of daily living	4.24	5	1.19
23. Work Capacity	4.11	5	1.25
Social Relations
17. Social Inclusion	3.68	4	1.40
25. Personal relationships	3.71	5	1.52
26. Support from friends	3.56	4	1.38
Environmental Health
12. Physical safety	4.41	5	1.09
13. Physical environment	4.12	5	1.24
16. Financial resources	2.87	3	1.47
18. Information for daily living	4.77	5	0.79
19. Participation in leisure activities	3.53	4	1.55
27. Conditions of living place	3.83	5	1.46
28. Access to Health Services	4.76	5	0.74
29. Access to transportation	4.33	5	1.13
Spirituality and Personal beliefs
7. Personal life meaning	4.32	5	1.12
8. Forgiveness and blame	3.57	4	1.59
9. Concerns about the Future	3.04	3	1.60
10. Death and dying	2.99	3	1.54

Table 3 depicts the mean scores, medians, and standard deviations for each of the 30 questions. The overall quality of life had a mean score of 3.5, signifying most participants had an above average QoL. The QoL specifically concerning health had a similar mean score of 3.6. All other means support one of the aforementioned domains. The lowest mean scores were for Q3, Q30, Q16, and Q10, which inquired about negative feelings, death, financial stability, and pain or discomfort. The highest mean score was for access to health services and transportation, indicating that participants believe their healthcare access meets their needs.

Section 4: Qualitative component of the study

The qualitative component of this study, drawn from systematically selected participants, enriches the understanding of how women living with HIV experience and navigate the domains outlined in the WHOQOL-HIV BREF framework. Thematic analysis revealed six core areas listed below. These themes are discussed below in relation to the quantitative data (Table III), which provides descriptive statistics across six domains of QoL.

1. Support Systems for ART Access and Adherence:

Participants described a combination of self-reliance, familial assistance, and support from TSA-CHDP in facilitating ART adherence. Support systems were not mutually exclusive; respondents often utilized more than one simultaneously, depending on life circumstances.

A significant proportion (70%) reported receiving tangible assistance from the CHDP network. Support included medication reminders, health monitoring, and delivery of ART medication, particularly during times of mobility restrictions or personal illness. As one participant shared:

“I usually go and get them myself. When I was in Chennai for some time, the Asaripallam* network staff Mrs. Revathi sent me ART tablets 5 times.”

Asaripallam – Kanyakumari Medical College Hospital

This reflects the high mean scores observed in the Level of Independence domain, particularly:

· Mobility (M = 4.40; SD = 1.13)

· Activities of Daily Living (M = 4.24; SD = 1.19)

· Work Capacity (M = 4.11; SD = 1.25)

These scores suggest that participants maintain a high level of independence in managing their health, often reinforced by supportive structures such as CHDP.

2. Familial Involvement and Social Relationships:

Approximately 40% of respondents cited the active involvement of family members—especially children, siblings, and parents—in helping to manage ART adherence, particularly during periods of poor health or logistical difficulties. One participant described:

“During the Coronavirus/Covid-19 period, the network staff from Nagercoil helped me. When I have health issues, I go to the hospital with my kids and get the tablets.”

This theme aligns closely with the mean scores observed in the Social Relations domain, in areas of:

· Personal Relationships (M = 3.71; SD = 1.52)

· Social Inclusion (M = 3.68; SD = 1.40)

These results highlight that interpersonal and community ties remain crucial to ART adherence and emotional support.

3. Reminder Systems for Medication Schedules:

Participants detailed various strategies employed to remember ART dosing and refill schedules. Commonly reported systems included written reminders in ART logbooks, routine counseling calls, and involvement of family members, especially children, in daily medication routines. As one participant described,

“Every month, the CHDP counselor [name redacted] calls me to check if I got the tablets and she also comes home every month to check on my health.”

These mechanisms likely contribute to the relatively high independence indicated in the 'Dependence on Medication' variable (M = 3.92, SD = 1.44), illustrating that self-management is effectively supported by external monitoring and interpersonal accountability.

4. Accessibility of ART and Environmental Considerations

All participants unanimously reported regular and reliable access to ART medication, with no documented shortage in availability. However, transportation logistics emerged as a recurring barrier, particularly for participants in rural areas reliant on early morning buses or expensive auto-rickshaws. One participant reported,

“Bus comes at 7 in the morning. After getting the tablets, while returning, if I miss the bus, I need to take an auto rickshaw.”

This is consistent with the high scores in the Environmental Health domain:

· Access to Health Services (M = 4.76; SD = 0.74)

· Access to Transportation (M = 4.33; SD = 1.13)

· Information for Daily Living (M = 4.77; SD = 0.79)

However, Financial Resources showed a relatively lower mean score (M = 2.87; SD = 1.47), reflecting the economic strain that travel and auxiliary care expenses may impose.

5. Impact of Opportunistic Illness on ART Adherence:

Participants noted that despite episodes of illness, adherence to ART remained a priority, with many continuing to collect medication independently or with family assistance. For example, one participant said:

“On the days that I get sick, I go to get the tablets by myself.”

This sense of resilience complements the broader Physical Health domain, particularly:

· Energy in Daily Life (M = 3.57; SD = 1.47)

· Satisfaction with Sleep (M = 3.57; SD = 1.48)

6. Knowledge and Empowerment Through Information Access:

Participants emphasized the role of CHDP staff, hospital networks, training camps, and community awareness sessions as primary sources of up-to-date information about ART. This empowerment supports ongoing engagement in treatment and enhances autonomy. One participant shared:

“I got new information about ART from the Asaripallam Counselor. I get additional information through the CHDP training classes, medical camps and the awareness classes.”

These findings are echoed in the high score for Information for Daily Living (M = 4.77), which relates to themes of self-efficacy, especially within the Spirituality and Personal Beliefs domain (e.g., Personal Life Meaning: M = 4.32, SD = 1.12).

These findings suggest that multi-level support systems, robust community health networks, and structured informational support significantly enhance ART adherence and overall QoL for women living with HIV. While logistical and financial challenges persist for some, the collective influence of familial, community, and institutional support helps mitigate their impact, promoting sustained engagement in treatment and improved well-being.

DISCUSSION:

Overall, this study focused on holistically evaluating the experiences and QoL of widows living with HIV in the Kanyakumari and Tirunelveli districts. In its compilation, the data indicate how medication adherence improves QoL from a physical health standpoint. However, to improve the psychological and social state of QoL, external initiatives must be implemented. The present research reveals a direct relationship between medication adherence and QoL. While all participants used ART, 70% of participants have been patients for 10-20 years, indicating long-term engagement with treatment. Taking the medication adherence specifically into consideration, 47% of participants had good adherence, and 40% had moderate adherence. As 87% of participants reported positive medication adherence, there is a strong correlation with health-related quality of life (HRQOL). Respondents who adhered to their medication schedules reported a higher QoL in the WHOQOL-HIV BREF regarding their overall health.

Similar to this study, previous studies have shown a consistent correlation between high-level medication adherence and a better QoL, especially among concentrated areas of HIV⁷. Past research has also demonstrated a similar positive association, specifically with QoL and CD4 T cell counts (b = 0.0011, p = 0.021), suggesting that effective ART contributes to better health^8. In the current study, this is represented in the mean QoL score for general health of 3.6, where most participants rated their health as above average. Considering this, physical health yielded a transformed score of 58. Based on the scale used for transformed scores, any value between 41 and 60 indicates a “good” QoL. This score of 58 falls in the upper range of this classification, indicating that study participants reported a positive, increased sense of physical QoL. These findings corroborate a direct correlation between medication adherence and scores in the quality of health and physical domains. Such findings were corroborated by a study conducted by Zhong et al. in China, which examined HRQOL and its associated factors among individuals living with HIV/AIDS. The study reported a physical health summary score of 53.66±6.80 and a mental health summary score of 51.31±7.66^9. Notably, factors such as younger age, higher levels of education, elevated CD4 lymphocyte counts, fewer reported symptoms, and a healthy body mass index were significantly correlated with improved HRQOL^9.

The present study also aligns closely with the findings of Nyamathi et al., who conducted a cross-sectional study among 400 women living with HIV (WLWH) in rural Andhra Pradesh, a neighboring state to Tamil Nadu. Both studies highlight the significant impact of sociodemographic factors, social support, and internalized stigma on the QoL of WLWH in rural India. In the present study, a substantial proportion of participants were aged between 40 and 49 years (56%), had limited education (38% with only primary schooling and 9% with no formal education), and resided in rural areas (64%). Similarly, Nyamathi et al. reported that rural WLWH often lacked formal education and employment opportunities, which contributed to their low QoL scores^8. Both studies underscore the vulnerability of widowed women, with present research indicating that 97% believed they contracted HIV from their spouse’s post-marriage.

In both studies, social support forms and internalized stigma worked as critical determinants of QoL. Present research revealed that the primary sources of support were from self (53%), CHDP social networks (26%), and family members (14%). In previous research, it was found that most participants reported little to no social support^8. Through a multivariable analysis, Nyamathi et al. concluded a positive association between QoL and social support (b = .260, p < .0001), suggesting the need for interventions that enhance social support networks for WLWH^8. Internalized stigma also appeared to perpetuate lower QoL scores. In the results of previous research, high levels of internalized stigma were reported among participants, which was negatively associated with QoL (b = −0.232, p<0.0001)^8. This starkly contrasts the results from present research, which noted that 86% of participants disclosed their ART status to family members. Whereas in the past, HIV-positive patients were not likely to disclose their status due to shame or fear of abandonment, present research shows disclosure of status is common among WLWH^10.However, as corroborated by past research, stigma exists against PLHIV and often negatively influences their overall well-being. For this reason, it is imperative to address the stigma through community education and support programs.

Social relationships were also evaluated, and the domain itself yielded a score of 21, the lowest among all measured domains. This score reflects poor social well-being and suggests that many HIV-positive widows experience significant social isolation and limited support from their communities. These findings align closely with those reported by Ninnoni et al., who found that an overwhelming 99% of HIV-positive individuals in a resource-limited setting experienced perceived stigma, and over 30% suffered from loneliness^11. Both studies emphasize the severe social impact of living with HIV, particularly among women, and highlight how stigma, lack of social inclusion, and weak support networks contribute to a diminished QoL. These results reinforce the importance of integrating psychosocial support, stigma-reduction interventions, and community-based care into HIV treatment strategies, especially in rural and underserved regions.

Furthermore, the qualitative findings from the present study underscore the multifaceted support systems that facilitate ART adherence among women living with HIV in rural Tamil Nadu. Participants highlighted the pivotal roles of self-reliance, family involvement, and assistance from CHDP. Notably, 70% of participants received tangible support from CHDP networks, including medication reminders and health monitoring, which contributed to high levels of independence in managing their health, as reflected in the Level of Independence domain scores. Family members, particularly children and siblings, also played a significant role in supporting ART adherence during periods of illness or logistical challenges. Various reminder systems, such as counseling calls and involvement of family members in medication routines, further bolstered adherence. Despite consistent access to ART medication, transportation logistics posed challenges, especially for participants in rural areas, highlighting the economic strain associated with travel and auxiliary care expenses. Nevertheless, participants demonstrated resilience, maintaining ART adherence even during episodes of illness, and emphasized the importance of knowledge and empowerment through information access provided by CHDP staff and community awareness sessions.

These findings align with existing literature emphasizing the critical role of household and community support in ART adherence. A systematic review by Masquillier et al. examined the social and structural determinants of household support for ART adherence in low- and middle-income countries. The review found that household dynamics such as gender norms significantly influence the type and quality of support provided to individuals living with HIV^12. Stigma and health system dysfunction were also identified as barriers to adequate and effective support^12. The study concluded that interventions aimed at improving ART adherence should consider these social and structural factors to enhance household support mechanisms.

This study underscores the role of consistent ART adherence in enhancing the overall QoL for widowed women living with HIV in the Kanyakumari and Tirunelveli districts. The findings demonstrate that while adherence significantly improves physical health, independence, and functional well-being, it does not fully alleviate the challenges associated with social isolation, stigma, and financial vulnerability. Despite medical advancements and community-based support, widows continue to face marginalization and limited emotional support from their surroundings. Support from programs such as the CHDP and the involvement of family members proved instrumental in facilitating access to ART, medication adherence, and emotional resilience. These multidimensional support structures contribute to participants’ sense of autonomy and ability to manage their health. Moving forward, future research should study the need for integrated, gender-sensitive, and child-inclusive interventions that not only sustain ART adherence but also improve the social, psychological, and economic well-being of women/families living with HIV.

STATEMENTS AND DECLARATIONS:

FUNDING:

This study was financially supported by a grant from TSA-CHDP, which allocated funding for transportation and meals for participants attending interview sessions conducted at the The Salvation Army Catherine Booth College of Nursing.

COMPETING INTERESTS:

Financial Interests:

Ms. Sahana Premkumar declares that she has no financial or personal conflicts of interest to disclose. Mrs. J. Agnes Philo is an Assistant Professor at TSA Catherine Booth College of Nursing, and Dr. T. Angel Priya serves as the principal of the same institution. Mr. Benjamin Dhaya is the Director of TSA Catherine Booth Hospital and TSA-CHDP. Ms. Pramela Thangaswamy is employed as a Counsellor under the Integrated Health Initiative (IHI) – Phase 2 within the TSA-CHDP. As the research was conducted at the Salvation Army Catherine Booth College of Nursing and utilized participant data accessed through the TSA-CHDP, it must be acknowledged that all authors, except Ms. Sahana Premkumar, are affiliated with the institution.

ETHICS APPROVAL:

This study received ethical approval from the Institutional Ethics Committee of the Salvation Army Catherine Booth College of Nursing in Nagercoil on July 22, 2024. All research procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and the policies and guidelines of TSA-CHDP. Informed written consent was obtained from all participants before the study.

CONSENT TO PARTICIPATE AND PUBLISH:

Informed written consent was obtained from all individual participants before they participated. The authors further affirm that all participants provided written consent for the use of their anonymized data in publications, with all personally identifiable information duly removed to ensure confidentiality.

AUTHORS CONTRIBUTIONS:

The study’s vision and selection of the research tool were masterfully crafted by Mrs. J. Agnes Philo. Under the guidance of Dr. Angel Priya and Mr. Benjamin Dhaya, Ms. Pramela Thangaswamy prepared materials and translated tools. The collective effort in data collection was passionately carried out by Ms. Sahana Premkumar, Mrs. J. Agnes Philo, and Ms. Pramela Thangaswamy. Mrs. J. Agnes Philo conducted the quantitative data analysis, and Ms. Sahana Premkumar and Ms. Pramela Thangaswamy conducted the qualitative analysis. The initial draft of the manuscript emerged through the collaboration of Ms. Sahana Premkumar and Mrs. J. Agnes Philo. Every author dedicated themselves to the review and revision of the manuscript, culminating in a final version that is embraced and approved for submission.

ACKNOWLEDGMENTS:

This study would not have been possible without the invaluable assistance and cooperation of the staff of the Salvation Army Community Health Development Programme, who facilitated contact with participants and provided essential support, including transportation and translation services. Sincere thanks are also extended to the Salvation Army Catherine Booth College of Nursing for providing the necessary infrastructure and a conducive environment for conducting the interview sessions. Most importantly, we express our heartfelt gratitude to the widows living with HIV who generously shared their time, experiences, and insights, without whom this study would not have been possible.

REFERENCES:

1. Centers for Disease Control and Prevention. (2024, January 24). About HIV. CDC. Retrieved August 21, 2024, from https://www.cdc.gov/hiv/about/index.html

2. National Institutes of Health. (2025, March 31). The Stages of HIV Infection. HIVinfo National Institutes of Health. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/stages-hiv-infection

3. Ray, I., Hasan, M. M., Shah, P. A., Sahito, A. M., Sarkar, A., Ghosh, D., Bardhan, M., Mukerjee, N., and Essar, M. Y. (2022). HIV epidemic amidst COVID-19 pandemic in India: a conundrum for the country's healthcare system. Epidemiology and Infection, 150, e112. https://doi.org/10.1017/S095026882200098X

4. Kemnic, T. R., and Gulick, P. G. (2022, September 20). HIV antiretroviral therapy. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513308/

5. Zhao, Y., Wu, Z., McGoogan, J. M., Shi, C. X., Li, A., Dou, Z., Ma, Y., Qin, Q., Brookmeyer, R., Detels, R., and Montaner, J. S. G. (2018, March 1). Immediate antiretroviral therapy decreases mortality among patients with high CD4 counts in China: A nationwide, retrospective cohort study. Clinical Infectious Diseases, 66(5), 727–734. https://doi.org/10.1093/cid/cix878

6. National Aids Control Organization. (2016, October 25). ART treatment | National AIDS control organization, Ministry of Health and Family Welfare, Government of India. ART Treatment. https://naco.gov.in/treatment

7. Sakthivel, V., Krishnasamy, V., and Mehalingam, V. Level of Medication Adherence and its Associated Factors among Patients Receiving Antiretroviral Therapy at a Tertiary Care Hospital in South India. Journal of Caring Sciences. 2020; 9(2): 93–97. https://doi.org/10.34172/jcs.2020.014

8. Nyamathi, A. M., Ekstrand, M., Yadav, K., Ramakrishna, P., Heylen, E., Carpenter, C., Wall, S., Oleskowicz, T., Arab, L., and Sinha, S. Quality of Life Among Women Living with HIV in Rural India. The Journal of the Association of Nurses in AIDS Care: JANAC. 2017; 28(4): 575–586. https://doi.org/10.1016/j.jana.2017.03.004

9. Zhong, H., Wei, F., Song, Y., Chen, H., and Ni, Z. Health-related quality of life and associated factors among people living with HIV/AIDS in Sichuan, China: A cross-sectional study. Frontiers in Public Health. 2023; 11. https://doi.org/10.3389/fpubh.2023.1133657

10. Madi, D., Gupta, P., Achappa, B., Bhaskaran, U., Ramapuram, J. T., Rao, S., and Mahalingam, S. HIV Status Disclosure Among People Living with HIV in the Era of Combination Antiretroviral Therapy (cART). Journal of clinical and diagnostic research: JCDR. 2015; 9(8): OC14–OC16. https://doi.org/10.7860/JCDR/2015/12511.6373

11. Ninnoni, J. P. K., Osei-Yeboah, J., Ofori, M. F., and Opare-Lokko, E. Psychosocial experiences of stigma among people living with HIV: A cross-sectional study in a Ghanaian population. BMC Psychiatry. 2023; 23(1): 720. https://doi.org/10.1186/s12888-023-04643-w

12. Masquillier, C., Wouters, E., Mortelmans, D., and van Wyk, B. Social and Structural Determinants of Household Support for ART Adherence in Low- and Middle-Income Countries: A Systematic Review. International Journal of Environmental Research and Public Health. 2020; 17(11): 3808. https://doi.org/10.3390/ijerph17113808

Received on 01.04.2026 Revised on 18.04.2026

Accepted on 04.05.2026 Published on 05.05.2026

Available online from May 09, 2026

A and V Pub Int. J. of Nursing and Med. Res. 2026; 5(2):55-62.

DOI: 10.52711/ijnmr.2026.13

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

Adherence to Antiretroviral Therapy and Quality of Life among Widows Living with HIV and AIDS in South India

The data were analyzed and organized as follows:

Section 1: Description of baseline variables of the study subject.

Section 2: Medication Adherence Levels.

Section 3: Score distribution of WHOQOL-HIV.

BREF:

Section 4: Qualitative component of the study:

Section 1: Description of baseline variables of the study subject.

Section 3: Score distribution of WHOQOL-HIV BREF

Section 4: Qualitative component of the study

1. Support Systems for ART Access and Adherence:

2. Familial Involvement and Social Relationships:

3. Reminder Systems for Medication Schedules:

4. Accessibility of ART and Environmental Considerations

5. Impact of Opportunistic Illness on ART Adherence:

6. Knowledge and Empowerment Through Information Access: