Poor Well-Being in HIV Associated With SDOH Adversities

Women living with multiple adversities that tie to social determinants of health (SDOH) were found to have poor wellbeing when living with HIV, according to a study published in HIV Medicine.1 The researchers emphasized that these women require tailored interventions to properly address this gap in care.

Social marginalization is common in women living with HIV in Canada, which can affect the long-term health outcomes for these women, given the intersection between SDOH and health outcomes.2 SDOH can encompass areas including where a patient is born, where they work, and where they live that can affect their access to health care and health practices. The study aimed to evaluate the relationship between the classes of SDOH and wellbeing, specifically in regard to the co-occurrence of SDOH adversities and their association with wellbeing.

Women with HIV in Canada had high adversity in regard to SDOH when accessing care | Image credit: LIGHTFIELD STUDIOS - stock.adobe.com

The study used data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study that was collected from 2013 to 2018. The women included all lived in British Columbia, Ontario, or Quebec. Participants included any cisgender, transgender, or gender-queer woman who was aged 16 years or older and living with HIV. Income, food insecurity within the previous year, substance use, housing security, stigma surrounding HIV, and social support were all SDOH that were assessed at baseline. Outcomes regarding well-being included adherence to antiretroviral therapy (ART), barriers to accessing care, gender or racial discrimination, and depressive symptoms measured with the Center for Epidemiologic Studies Depression Scale.

A total of 1422 participants were included in the study at baseline, 1243 at the first follow-up, and 934 at the second follow-up. The participants had a mean (SD) age of 42.8 (10.6) years.

A total of 26.5% of the participants had low adversity related to SDOH, including having food security, social support, high income, and no reports of violence. A total of 42.9% of women reported medium adversity related to SDOH, which included an elevated HIV stigma, high exposure to violence, low social support, and food insecurity. However, this group had low substance use and secure housing.

A total of 30.6% of participants reported high adversity related to SDOH, including low income, food insecurity, high levels of stigma surrounding HIV, violence, low social support, and substance use. Indigenous participants made up 38% of this group, and 37.9% of newly diagnosed women with HIV were in this group as well.

Women in the high adversity group had greater barriers to accessing care (adjusted β coefficient [aβ], 0.32; 95% CI, 0.19-0.45), lower odds of reporting undetectable viral load (adjusted OR [aOR], 0.46; 95% CI, 0.21-0.989), racial discrimination (aβ, 3.42; 95% CI, 1.72-5.12), higher levels of depression (aOR, 2.52; 95% CI, 1.71-3.71), and gender discrimination (aβ, 3.14; 95% CI, 1.42-4.87).

There were some limitations to this study. Information was all self-reported and thus could be subject to recall bias and social desirability bias. The range of SDOH was constrained due to using secondary data. The study population was limited to women, which could have excluded the outcomes of SDOH on men living with HIV.

The researchers concluded that a “one-size-fits-all approach to HIV care is insufficient.” Investing in programs and interventions that address the unique challenges that plague women with HIV living with high barriers of SDOH should be the focus of health care providers and health care systems for reducing these barriers to care.

References

1. Admassu Z, Logie CH, Vahedi L, et al. Longitudinal associations between social determinants of health and well-being among women living with HIV in Canada: a latent class analysis. HIV Med. Published online April 14, 2025. doi:10.1111/hiv.70031
2. Social determinants of health (SDOH). CDC. Accessed April 15, 2025. https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html