Social–structural factors associated with supportive service use among a cohort of HIV-positive individuals on antiretroviral therapy

Abstract

As mortality rates decrease in British Columbia, Canada, supportive services (e.g. housing, food, counseling, addiction treatment) are increasingly conceptualized as critical components of care for people living with HIV/AIDS. Our study investigates social and clinical correlates of supportive service use across differing levels of engagement. Among 915 participants from the Longitudinal Investigations into Supportive and Ancillary health services (LISA) cohort, 742 (81%) reported using supportive services. Participants were nearly twice as likely to engage daily in supportive services if they self-identified as straight (95% confidence interval [CI], adjusted odds ratio [AOR]: 1.69), had not completed high school (95% CI, AOR: 1.97), had an annual income of < $15,000 (95% CI, AOR: 1.81), were unstably housed (95% CI, AOR: 1.89), were currently using illicit drugs (95% CI, AOR: 1.60), or reported poor social capital in terms of perceived neighborhood problems (95% CI, AOR: 1.15) or standard of living (95% CI, AOR: 1.70). Of interest, after adjusting for sociodemographic and socioeconomic variables, no clinical markers remained an independent predictor of use of supportive services. High service use by those demonstrating social and clinical vulnerabilities reaffirms the need for continued expansion of supportive services to facilitate a more equitable distribution of health among persons living with HIV.

Keywords:

• support service
• ART
• HIV
• social determinants of health
• Canada

Acknowledgements

The LISA research team is thanked for the collaboration of our various research sites. We are inspired by their dedication to their clients and the communities they serve. We are also grateful to the contributions of our Community Advisory Committee (CAC) and the coinvestigators of the LISA project: Dr Rolando Barrios, Dr David Burdge, Dr Marianne Harris, Dr David Henderson, Dr Thomas Kerr, Dr Julio S.G. Montaner, Dr Thomas Patterson, Dr Eric Roth, Dr Mark W. Tyndall, Dr Brian Willoughby, and Dr Evan Wood. We would especially like to thank the participants of the LISA study who trust us with intimate information and share their stories in hopes of supporting research projects that will make a difference in their communities. We would also like to thank Svetlana Draskovic, Nada Gataric, and the staff at the British Columbia Centre for Excellence in HIV/AIDS who contributed to this project. This study was supported through funding from Canadian Institutes of Health Research.