Association of social determinants of health with self-rated health among Australian gay and bisexual men living with HIV

Abstract

Despite a vast improvement in the survival of people living with HIV (PLHIV) since the introduction of combination antiretroviral treatment (cART), little change in the self-rated health of PLHIV has been observed since the introduction of cART in Australia. Difficulties with attaining employment or achieving financial security have been noted as some of the key challenges still facing PLHIV in the post-cART era. As a result, we investigated the independent association of a number of key social determinants of health with self-rated health among HIV-positive gay and bisexual men in Australia. Data from two recent national, cross-sectional surveys of PLHIV (the HIV Futures 5 and 6 surveys) were used. Logistic regression was used to assess the independent association of ethnicity, region of residence, education level, employment status, after-tax income, experience of HIV-related discrimination, level of social support, relationship status and recent sexual activity with reporting good–excellent self-rated health, after adjusting for clinical factors and other social determinants of health. Multiple imputation was used to estimate missing data for variables with >5% missing data. Of the 1713 HIV-positive gay/bisexual men who responded to the HIV Futures 5 and 6 surveys, information on self-rated health was available for 99.3%. Close to three-quarters of these respondents (72.1%) reported their self-rated health as good or excellent; the remainder (27.9%) reported their self-rated health as poor or fair. In multivariable analysis involving 89.3% of respondents, being employed, reporting recent sexual activity, a greater number of sources of social support and a higher weekly after-tax income were found to be independently associated with reporting good–excellent self-rated health. Despite the inability of this study to detect causal associations, addressing barriers to employment and sexual activity, and mechanisms to increase social support, is likely to have positive health effects for PLHIV in Australia.

Keywords:

• social determinants of health
• HIV
• Australia
• men who have sex with men
• living with HIV

Acknowledgements

We thank the HIV-positive Australians who completed the HIV Futures 5 and 6 surveys and shared their experiences of living with HIV in Australia. We also thank individuals and organisations in the HIV sector within Australia who assisted with recruiting participants for these studies, as well as staff of the Australian Research Centre in Sex, Health and Society (ARCSHS) who collected and processed the data from the surveys. We also thank the Commonwealth Department of Health and Ageing for funding the Living with HIV Program at ARCSHS.