Social determinants of health and self-rated health status: A comparison between women with HIV and women without HIV from the general population in Canada

RESEARCH ARTICLE Social determinants of health and self-rated health status: A comparison between women with HIV and women without HIV from the general population in Canada a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Shokoohi M, Bauer GR, Kaida A, Lacombe-Duncan A, Kazemi M, Gagnier B, et al. (2019) Social determinants of health and self-rated health status: A comparison between women with HIV and women without HIV from the general population in Canada. PLoS ONE 14(3): e0213901. https://doi.org/10.1371/journal.pone.0213901 Editor: Olalekan Uthman, The University of Warwick, UNITED KINGDOM Received: April 30, 2018 Accepted: March 4, 2019 Published: March 21, 2019 Copyright: © 2019 Shokoohi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data cannot be shared publicly because they contain sensitive human subjects information. The Women’s College Research Institute Women and HIV Research Program Data Access Coordinator have provided the opportunity of having access to the data for researchers and students who meet the criteria for access to confidential data. Applicants should contact Angela Underhill, the current Data Access Coordinator, via . The criteria for access to the confidential data are Mostafa Shokoohi ID1*, Greta R. Bauer1, Angela Kaida2, Ashley Lacombe-Duncan3,4, Mina Kazemi5, Brenda Gagnier5, Alexandra de Pokomandy6,7, Mona Loutfy5,8,9, On Behalf of the CHIWOS Research Team¶ 1 Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada, 2 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada, 3 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada, 4 School of Social Work, University of Michigan, Ann Arbor, MI, United States of America, 5 Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada, 6 Department of Family Medicine, McGill University, Montreal, Quebec, Canada, 7 McGill University Health Centre, Montreal, Quebec, Canada, 8 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, 9 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada ¶ The CHIWOS Research Team is detailed in the Acknowledgments. * Abstract Background Women living with HIV (WLWH) continue to experience poorer outcomes across the HIV care cascade and overall health, an appreciable proportion of which may not be diseaserelated but due to socio-structural barriers that impact health. We compared socio-structural determinants of health and self-rated health between WLWH and expected general population values. Methods Prevalences of socio-structural determinants and self-rated health were estimated from 1,422 WLWH aged 16+ in the 2013–2015 Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS). Prevalences were also estimated from 46,831 general population women (assumed HIV-negative) in the 2013–2014 Canadian Community Health Survey (CCHS), standardized to the age/ethnoracial group distribution of WLWH. Standardized prevalence differences (SPDs) and 95% confidence intervals (CI) were reported. Results Compared to general population women, a higher proportion of WLWH reported annual personal income <$20,000 (SPD 42.2%; 95% CI: 39.1, 45.2), indicating that 42.2% of WLWH experienced this low income, in excess of what would be expected of Canadian women of similar ages/ethnoracial backgrounds. A higher proportion of WLWH reported severe food PLOS ONE | https://doi.org/10.1371/journal.pone.0213901 March 21, 2019 1 / 16 Social determinants of health in women living with HIV outlined at the CHIWOS study site (home: http:// www.chiwos.ca/home/?lang=en; data access: http://www.chiwos.ca/chiwos-study/chiwosdocuments/?doing_wp_cron=1552088039. 6901860237121582031250&lang=en_). Funding: CHIWOS was funded by a Canadian Institutes of Health Research (CIHR) Operating Grant (grant# MOP-111041), the CIHR Canadian HIV Trials Network (CTN 262), the Ontario HIV Treatment Network, and the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. CCHS is a national survey conducted by Statistics Canada. Competing interests: The authors have declared that no competing interests exist. insecurity (SPD 43.9%; 40.2, 47.5), poor perceived social support (SPD 27.4%; 22.2, 33.0), frequent racial (SPD 36.8%; 31.9, 41.8) and gender (SPD 46.0%; 42.6, 51.6) discrimination, and poor/fair self-rated health (SPD 12.2%; 9.4, 15.0). Conclusions Significant socio-structural inequalities and lower self-rated health were found among WLWH compared to general population women. Such inequities support the integration of a social-determinants approach, social service delivery, and programming into HIV care, with additional resource allocation tailored to the particular needs of WLWH. Introduction Research has shown substantial improvements in health outcomes of people living with HIV (PLWH) since the introduction of combination antiretroviral therapy (cART); for example, life expectancy for those who receive cART has been approaching that of the general population [1, 2]. Despite the remarkable successes achieved in HIV outcomes, they are still not ideal, particularly among women living with HIV (WLWH). A recent Canadian study demonstrated that reductions in health-adjusted life expectancy among those living with HIV were larger for women than men [2]. In addition, Canadian studies have documented that a higher proportion of women experience poorer “quality of care” in Canada, indicating the existence of gender inequities in access and adherence to HIV treatment even in a universal healthcare system [3, 4]. Although HIV is now widely known as a chronic but manageable illness where appropriate care and treatment services are accessible [5], multiple interpersonal and structural factors–situated within social determinants of health (SDoH), continue to dampen HIV care and treatment efforts. The World Health Organization (WHO) defines the SDoH as “the conditions in which people are born, grow, live, work, and age.”[6] Literature has uncovered the contribution of these socio-structural disadvantages in shaping the HIV epidemic among PLWH [7–9]. In turn, living with HIV can also cause greater vulnerability to socio-structural disadvantages; for example, PLWH experience food insecurity even after an HIV diagnosis, and employment loss, particularly among women [10, 11]. Despite advances in HIV interventions, PLWH continue to experience challenges to maintaining their health due to the barri (...truncated)