Structural model of health and its impact on quality of life among people living with HIV in Miri Sarawak East Malaysia

The global HIV pandemic continues to pose significant health and socioeconomic challenges. Despite advancements in antiretroviral therapy (ART), people living with HIV (PLHIV) face profound physical, psychological, and social impacts that affect their quality of life (QoL). This study aims to evaluate the QoL among PLHIV in Miri, Sarawak, and to examine its relationship with demographic factors. This cross-sectional study included 182 PLHIV from the Infectious Disease Clinic at Miri Hospital, Sarawak. Eligible respondents were assessed using the self-administered World Health Organization Quality of Life Questionnaire-Short Version (WHOQoL-BREF). Data on sociodemographic status and QoL were collected and analysed using descriptive statistics and structural equation modeling. The SEM consisting of all demographic and QoL domains confirmed that gender and marital status had a direct effect on social relationships (β = 0.243, P < 0.001 and β = − 0.134, P = 0.019, respectively). Psychological well-being and environmental perceptions positively influenced both overall QoL (β = 0.318, P = < 0.001 and β = 0.262, P = 0.013, respectively) and general health perceptions QoL (β = 0.275, P = 0.009 and β = 0.287, P = 0.002, respectively). Correlation analysis demonstrated fair to moderately strong positive relationships among all QoL domains, with the strongest correlation observed between the psychological and environment domains. The model indicates adequate fit: CFI = 0.997; TLI = 0.995; SRMR = 0.041; RMSEA = 0.016, 90% CI = 0.000–0.071, probability RMSEA = 0.793. The findings highlight the multifaceted challenges faced by PLHIV in Sarawak, emphasizing the need for tailored interventions to enhance their QoL. Addressing psychological, social, and environmental factors, particularly physical health, is crucial for improving overall well-being in this population. This study provides essential insights for healthcare providers and policymakers to formulate effective strategies for QoL improvement among PLHIV in East Malaysia.