Gender, working status, and access to HIV care among people who are HIV positive in Eswatini

ABSTRACT

This study investigated the relationship between gender, working status, and access to HIV care and explored whether working status mediates the relationship between gender and access to HIV care. Nationally representative data from the 2016 Swaziland HIV Incidence Measurement Survey used. Sample comprised of 2,826 adults positive for HIV. Both 30-day and 1-year employment records were used to define working status. Access to HIV care was defined using data on both HIV viral load suppression and current antiretroviral therapy (ART) enrollment. People who worked in the past 12 months had a significantly lower likelihood of current ART enrollment (odds ratio [OR] 0.75; 95% confidence interval [CI]: 0.62–0.91) and viral load suppression (OR 0.78; 95% CI: 0.67–0.92). Working in the past 30 days was also significantly associated with current ART enrollment (OR 0.71; 95% CI: 0.59–0.85) and viral load suppression (OR 0.78; 95% CI: 0.66–0.93). The negative influence of working status on access to HIV care (current ART enrollment and viral load suppression) was stronger in men than in women. Working status partially explained the relationship between gender (male) and access to HIV care. Time constraints are a likely explanation for this.

KEYWORDS:

• HIV
• gender
• working status
• antiretroviral therapy
• HIV viral load
• access to HIV care

Acknowledgements

This manuscript was edited by Wallace Academic Editing. The authors thank the Population-based HIV Impact Assessment Project which conducted the national survey in Eswatini for the data that was analyzed in the study.

Declarations

Statements on funding

• This study was supported by the MOFA Taiwan Scholarship.

Statements on conflict of interest

• The authors have no relevant financial or non-financial interests to disclose.

• The authors have no competing interests to declare that are relevant to the content of this article.

• All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

• The authors have no financial or proprietary interests in any material discussed in this article.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study used data from the Swaziland HIV Incidence Measurement Survey (SHIMS 2) conducted in 2016. The survey obtained approval from Eswatini Health and Human Research Review Board and IRB from Colombia University. This study also obtained IRB from National Yang Ming Chiao Tung University.

Consent to participate

The SHIMS 2 survey obtained informed consent from all individuals who participated.

Authors contributions

All authors contributed to the conception and design and analysis of the study. Writing (Original draft) by Bongi Siyabonga Nkambule. Writing (review and editing) and supervision by Nicole Huang. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by the MOFA Taiwan Scholarship.