A global mixed methods study of hope aspirations and life perceptions among people living with HIV

Abstract Background With advancements in antiretroviral therapy (ART), HIV has evolved into a manageable chronic condition, shifting the focus of care from survival to quality of life. However, existing research has largely emphasized pathology and stigma, with limited attention to positive psychosocial constructs such as hope, aspirations, and life perceptions among people living with HIV across diverse cultural contexts. Objective This study aimed to explore and compare future orientations, hope, and life perceptions among people living with HIV across Asia, Africa, Europe, and the Americas, and to examine how these factors are associated with resilience and well-being within different cultural and socioeconomic contexts. Methods A convergent parallel mixed methods design was employed. The quantitative strand involved a cross-sectional survey of 352 participants recruited through global partner networks. Standardized measures assessed hope (Herth Hope Index), optimism (Life Orientation Test–Revised), life satisfaction (Satisfaction with Life Scale), resilience (Connor–Davidson Resilience Scale), and meaning in life (Meaning in Life Questionnaire). The qualitative strand consisted of in-depth interviews with 88 participants across four regions. Data were analysed using descriptive statistics, analysis of variance, and structural equation modelling for the quantitative strand, and reflexive thematic analysis for the qualitative strand. Findings were integrated using joint displays. Results Significant regional differences were observed in psychosocial outcomes, with participants from Africa reporting higher levels of hope (F(3,348)=8.91, p <.001) and resilience (F(3,348)=6.55, p <.001), while those from Europe reported higher life satisfaction (F(3,348)=3.14, p =.025). Structural equation modelling indicated that hope ( β =0.28, p <.001) and meaning in life ( β =0.21, p <.001) were positively associated with resilience, which in turn was associated with well-being ( β =0.58, p <.001). Qualitative findings provided contextual depth to these patterns, showing that higher hope and resilience were often grounded in community support and spirituality, whereas life satisfaction was linked to perceived structural stability and access to healthcare. Across regions, eight interconnected themes emerged, including redefining the future, family dynamics, spirituality, community support, stigma, advocacy, embodied experiences, and structural influences. Overall, integrated findings indicate that psychosocial well-being is shaped by both internal resources and broader cultural, social, and structural contexts. Conclusion People living with HIV actively construct meaningful and hopeful lives beyond their diagnosis. While experiences are globally shared, the pathways to hope and resilience vary across contexts. These findings contribute to a more nuanced understanding of psychosocial well-being and support the importance of culturally responsive and context-sensitive approaches to care.