Experts warn that social determinants continue to shape the quality of life of people living with HIV in Catalonia

A multidisciplinary group of experts, led by the Consorci de Salut Social de Catalunya and the Public Health Agency of Catalonia, and involving Dr Eugènia Negredo, Head of the Foundation’s HIV research line, has agreed on new lines of action to improve care and the quality of life of people living with HIV in vulnerable situations in Catalonia, placing the focus on a key idea: health goes beyond medical treatment.

The study, published in Enfermedades Infecciosas y Microbiología Clínica and led by these institutions, concludes that factors such as stigma, mental health and social conditions continue to have a direct impact on adherence to antiretroviral treatment and engagement with healthcare services, particularly among vulnerable populations.

A paradigm shift: from survival to quality of life

Advances in antiretroviral treatment have enabled many people living with HIV to achieve a life expectancy close to that of the general population. However, this medical success marks a new stage: ensuring not only survival, but also a good long-term quality of life.

According to the study, this requires adopting a comprehensive care model that takes into account aspects often overlooked in clinical practice, such as emotional wellbeing, social circumstances, stigma, mental health and ageing.

The most vulnerable, the most exposed

The study identifies several groups at higher risk of experiencing difficulties in treatment follow-up and in their relationship with the healthcare system: people born outside Spain, those facing social exclusion, and older adults.

These groups face multiple risk factors, such as mental health issues, cultural barriers and social instability, which may affect treatment adherence and increase the risk of disengagement from care.

In fact, lack of adherence is one of the main predictors of loss to follow-up, with consequences at both individual and public health level.

Twelve actions to transform the care model

To address these challenges, the expert group has defined 12 lines of action grouped into four main objectives:

1. Early detection of risk factors
2. Assessment of quality of life
3. Strengthening socio-healthcare coordination
4. Active patient participation in decision-making

Among the proposed measures, the following stand out:

• Early identification of social and clinical factors that may affect health
• The incorporation of quality-of-life indicators into HIV care
• Strengthening coordination between hospitals, social services and community organisations

Integrating mental health and the social dimension

One of the key conclusions is the need to strengthen the role of mental health and social services in HIV care.

The research proposes more effective integration of psychology and social work professionals into care teams, as well as improved coordination with the third sector to detect risk situations early and prevent loss to follow-up.

It also highlights the need to address emerging issues such as chemsex and the impact of stigma, which continue to affect the health and wellbeing of many people living with HIV.

A model focused on equity

The findings show that the proposed actions could have a positive impact across multiple dimensions, including improving treatment adherence, strengthening continuity of care and reducing health inequalities.

In this regard, the study proposes a replicable model based on coordination, participation and scientific evidence, with the aim of ensuring that no person living with HIV is left behind.