Social Factors Could Impact HIV Mortality Risk

Despite access to universal health care and medication, HIV-positive patients from Ontario are dying younger from the disease than other Canadians. These individuals are also dying at higher rates, according to a new study published by AIDS and Behavior.

These findings suggest that social determinants of health may be affecting HIV outcomes. These determinants include non-medical and non-genetic factors, including income, employment, education, and housing, according to the study authors.

The authors followed 602 patients with HIV recruited from community-based agencies. These individuals then conducted interviews with other HIV-positive patients to determine who was alive at 1, 3, and 5 years. If necessary, the patients used information from loved ones, friends, obituaries, and memorial lists.

The authors found that 53 out of 454 patients had died during follow-up, an equivalent of 22.3. deaths per 100,000. Comparatively, the death rate of the general population is 6.7 per 100,000 people.

HIV-positive patients who lived outside of Toronto had a higher mortality rate, at 59% compared with 42% of patients living in the Greater Toronto area, according to the study.

To determine the underlying reason for the difference in these results, the authors examined social factors. Of the total study population, 78% were unemployed, 68% had an income of less than $12,000 per year, 42% had been homeless, and 31% had a history of incarceration.

Patients who died during follow up were 16% more likely to have less than a high school education and 12% more likely to be unemployed. Additionally, this population was 18% more likely to have a history of homelessness and twice as likely to have been previously incarcerated compared with living patients, according to the study.

The researchers found that past incarcerations, homelessness, and poor self-rated health were significant risk factors for mortality among men who have sex with men. Both incarceration and homelessness are known to exacerbate health conditions and could affect HIV progression.

Caucasian ethnicity, history of incarceration and self-reported poor or fair health contributed to the mortality risk among HIV-positive women and heterosexual men, according to the study.

"Despite these incredible advances in science, we now need to pay much more attention to address the social and structural drivers affecting those living with HIV," said researcher Sean Rourke, FCAHS. "This means we need to address mental health and addiction issues, housing, social isolation and income supports, for example. We also need to make sure the health system is redesigned in ways to support access to coordinated patient center care and services for people living with a chronic disease so that they are not only living healthier, but conditions are in place so that they can thrive into older age."