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

• Published in: AIDS care Vol. 25; no. 8; pp. 937 - 947
• Main Authors: O'Brien, Nadia, Palmer, Alexis K., Zhang, Wendy, Michelow, Warren, Shen, Anya, Roth, Eric, Rhodes, Chelsey L., Salters, Kate A., Montaner, Julio S.G., Hogg, Robert S.
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis 01.08.2013; Taylor & Francis Ltd
• Subjects: Acquired Immune Deficiency Syndrome; Addiction; Adult; AIDS/HIV; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral therapy (ART); Biological and medical sciences; British Columbia; Canada; Cohort Studies; Cohorts; Determinants; Female; Health; Health care; Health Care Services; Health Services - statistics & numerical data; Health Services - utilization; Healthy food; HIV; HIV Infections - drug therapy; HIV Infections - psychology; Housing; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Longitudinal Studies; Male; Medical sciences; Medication Adherence - statistics & numerical data; Middle Aged; Miscellaneous; Mortality rate; Mortality Rates; Odds Ratio; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Service provision; Social Class; Social conditions & trends; social determinants of health; Social psychiatry. Ethnopsychiatry; Social services; Social Support; Sociocultural environment; Sociodemographic Factors; Socioeconomic Factors; Standard of Living; support service; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Vulnerability; Welfare; Canada; North America; America; British Columbia; British Columbia Canada; Context; Social environment; Human; Immunopathology; Antiretroviral agent; social determinants of health; ART; support service; Retroviridae; Pharmacotherapy; AIDS; Health service; Immune deficiency; Lentivirus; Therapeutic assistance; Infection; Virus; Canada; Treatment; HIV; Viral disease; Antiviral; Human immunodeficiency virus; Public health
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540121.2012.748866

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.