Food insufficiency, housing and health-related quality of life: results from the Positive Spaces, Healthy Places study

Abstract

Studies of people living with HIV who are homeless or unstably housed show a high prevalence of food insufficiency (>50%) and associated poor health outcomes; however, most evidence is in the form of cross-sectional studies. To better understand this issue, we conducted a longitudinal study to examine the impact of food insufficiency and housing instability on overall physical and mental health-related quality of life (HRQoL) among people living with HIV in Ontario. Six hundred and two adults living with HIV were enrolled in the Positive Spaces, Healthy Places study and followed from 2006 to 2009. Interviewer-administered questionnaires were used, and generalized linear mixed-effects models constructed to examine longitudinal associations between food insufficiency, housing instability and physical and mental HRQoL. At baseline, 57% of participants were classified as food insufficient. After adjusting for potential confounders, longitudinal analyses revealed a significant, negative association between food insufficiency and physical and mental HRQoL outcomes, respectively [effect size (ES) with 95% confidence interval (CI): (ES = −2.1, CI = −3.9,−0.3); (ES = −3.5, CI = −6.1,−1.5)]. Furthermore, difficulties meeting housing costs were shown to have additional negative impacts on mental HRQoL. Food insufficiency is highly prevalent among people living with HIV in Ontario, particularly for those with unstable housing. This vulnerable group of individuals is in urgent need of changes to current housing programmes, services and policies, as well as careful consideration of their unmet nutritional needs.

Keywords:

• HIV
• food insufficiency
• housing
• quality of life
• Ontario
• longitudinal design

Acknowledgements

The authors would like to thank all study participants for their involvement. We also wish to acknowledge the significant contributions of the our Peer Research Associates who played a key role in data collection and interpretation: D.B. Hintzen, J. Lauzon, Jim Truax, Marie Kayitesi, Marisol Desbiens, Mary M., Miguel Cubillos, Rob Rollins, Scott de Blois, Pius J. White, Michael J. Hamilton, James Gough, Jasmine Cotnam, Wayne Bristow and Mary Kato. We would like to acknowledge the Ontario AIDS service organizations who participated in the study: Positive Living Niagara, Bruce House, Elevate NWO, AIDS Committee of North Bay & Area, The AIDS Network, Toronto People With AIDS Foundation, Fife House, AIDS Committee of Toronto, Ontario Aboriginal HIV/AIDS Strategy, Regional HIV/AIDS Connection, Reseau ACCESS Network and HIV/AIDS Resources and Community Health. Lastly we would like to thank the leaders of PSHP for their continued passion and commitment to this work: Sean B. Rourke, Saara Greene, Ruthann Tucker, J.J. (Jay) Koornstra, Michael Sobota, Keith Hambly, James Watson, Stephen W. Hwang, Doe O’Brien-Teengs, Glen Walker, LaVerne Monette, Tsegaye Bekele and Jean Bacon.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors contribution

Sean Rourke conceived and designed the project, oversaw data collection, guided data analyses and is the senior responsible author for this manuscript. He is responsible for the integrity of the work as a whole. Stephanie Choi conducted data analyses and is responsible for interpretation of the data and drafting and finalizing the manuscript. Jason Globerman and Sarah Fielden contributed to the interpretation of the data, the drafting of the article and the review of the manuscript. Jay Koornstra, Keith Hambly, Glen Walker, Michael Sobota and Doe O’Brien-Teengs conceived the study, oversaw data collection and contributed to interpretation of data and review of the manuscript. James Watson participated in the design of the study and data collection, contributed to the interpretation data and reviewed the manuscript. Tsegaye Bekele conducted data analyses and participated in the writing of the manuscript. Ruthann Tucker conceived the study, contributed to its design and reviewed the manuscript. Saara Greene and Stephen Hwang conceived and designed the project, contributed to data interpretation and reviewed the manuscript. All authors have approved this version of the manuscript.

Additional information

Funding

AIDS Bureau, Ontario Ministry of Health and Long-term Care; Canadian Institutes of Health Research (CIHR).