Social Determinants of Health and Substance Use among Women Living with HIV in Canada: Inequalities and Impacts
Abstract
The objective of this doctoral research was two-fold: 1) to estimate inequalities in social determinants of health (SDoH), health-related quality of life, and substance use among women living with HIV (WLWH) compared to the general population of women; and 2) to assess the impact of the SDoH clusters on illicit drug use and heavy alcohol drinking among WLWH. For the first objective, estimates were obtained from 1,422 WLWH aged 16+ in the 2013-2015 Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS, time-point 1), and then compared with their counterparts estimated in 46,831 general population women in the 2013-2014 Canadian Community Health Survey (CCHS), standardized to the age/ethnoracial group distribution of WLWH. For the second objective, we used longitudinal data from the 2013-2017 CHIWOS at time-point 1 (N=1,422) and time-point 2 (N=1,252). Findings showed that compared to general population women, a higher proportion of WLWH reported adversities regarding the social determinants and poor/fair self-rated health status, and greater cigarette smoking and illicit drug use, but similar to lower likelihood of binge drinking. Latent class analysis was used to determine the clustering of SDoH. We identified four distinct classes: no/least SDoH adversities, discrimination/stigma, economic hardship, and most SDoH adversities. Inverse-probability weighted regression models showed a substantial difference in illicit drug use, and heavy alcohol drinking between no/least SDoH class and other SDoH classes. These findings underscore the need for novel approaches to address socio-structural adversities and substance use among WLWH. We also discuss additional implications and future research directions.