Subjective meanings of quality of life and related coping mechanisms: insights from a reflective thematic analysis among people living with HIV in Antwerp, Belgium

Despite advances in HIV treatment, people living with HIV face intersecting health and social challenges shaping their quality of life (QoL). Little is known about how people living with HIV in Belgium conceptualise their quality QoL, cope with stressors, and experience their HIV care. We conducted 18 purposively sampled in-depth interviews, analysing them inductively using reflexive thematic analysis from an interpretative perspective. Participants described good QoL as a balance across physical, mental, and social health, underpinned by socio-economic stability and legal security. Key influences included multi-morbidities, mental health, sexual wellbeing, and structural factors such as socio-economic contexts, migration-related challenges, multiple stigmata, and discrimination. Coping processes and professional support played mediating roles: adaptive strategies (e.g., acceptance, self-management, disclosure skills, community engagement) fostered resilience and agency, whereas maladaptive coping (e.g., social disconnection, rumination, substance use) reinforced vulnerability and care disengagement. We developed a data-grounded conceptual model linking health-related, psychosocial and structural factors with coping and professional support, illustrating trajectories towards QoL. Integrating social determinants of health, the study demonstrates that QoL is a contextual, evolving construct. Findings demonstrate the value of lived experiences to inform person-centered, stigma-sensitive integrated HIV care to improve QoL beyond viral suppression.