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Social Determinants of HIV Health and Prevention

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Occupational Safety and Health".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 14835

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Special Issue Editors

Prof. Dr. Liza M. Conyers

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Guest Editor

Department of Rehabilitation and Human Services, Penn State University, University Park, PA 16801, USA
Interests: vocational rehabilitation; HIV; employment; prevention; social determinants of health; psychosocial aspects of disability; chronic illness; health equity

Dr. KB Boomer

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Guest Editor

Department of Mathematics, Bucknell University, Lewisburg, PA 17837, USA
Interests: causal inference; social determinants of health

Special Issue Information

Dear Colleagues,

People living with human immunodeficiency virus (HIV) face numerous social and economic barriers, including poverty, unemployment/underemployment, job insecurity, and a lack of access to vocational services and education. Such barriers decrease their access to and retention in health care systems, resulting in vulnerability to suboptimal treatment adherence, poor clinical health outcomes, and poor quality of life [1,2]. Because of the significant likelihood of job loss and/or underemployment after diagnosis, HIV can have a devastating impact on one’s socioeconomic wellbeing [3,4]. Negative employment outcomes (e.g., job loss, underemployment) are more prevalent among key populations disproportionately impacted by HIV, including racial/ethnic minorities, transgender, gay, or bisexual individuals, substance users, older adults, and formerly incarcerated individuals; these populations are also disproportionately impacted by labor market discrimination, exclusion, and poverty. Unemployment and underemployment are associated with societal circumstances (e.g., homelessness, incarceration) and activities (e.g., sex work, illicit drug use) known to increase both the risk for acquiring and the prevalence of HIV and other co-morbidities; this complex, multi-layered context also creates significant barriers to health care access and employment services for individuals living with and at risk for HIV. However, it is important to note that these relationships may differ by quality of employment. Individuals with poor-quality jobs (high job insecurity, high psychological demands, and low decision authority) report similar levels of quality of life and depressive symptoms as those who are unemployed [5,6]. Likewise, among those who are employed, the type of employment matters. Individuals living with HIV with nonpermanent employment are at increased risk of death compared with those with stable employment [7]. Returning to work can also act as a barrier to medical care and can lead to an increase in stress and anxiety for some people living with HIV (PLHIV) [8–10]. For this Special Issue, we invite the submission of papers addressing these topics, especially those combining a high academic standard coupled with a practical focus on providing effective responses to the vocational development and employment needs of PLHIV or research reporting health and prevention outcomes across the HIV continuum of care.

Nachega, J.B.; Uthman, O.A.; Peltzer, K.; Richardson, L.A.; Mills, E.J. Amekudzi, K.; Ouedraogo, A. Association between antiretroviral therapy adherence and employment status: Systematic review and meta-analysis. World Health Organ. 2015, 93, 29–41.
Conyers, L.M.; Richardson, L.A.; Datti, P.A.; Koch, L.C.; Misrok, M. A Critical Review of Health, Social, and Prevention Outcomes Associated With Employment for People Living With HIV. AIDS Educ. Prev. 2017, 29, 475–490.
Mgbako, O.; Miller, E.H.; Santoro, A.F.; Remien, R.H.; Shalev, N.; Olender, S.; Gordon, P.; Sobieszczyk, M.E. COVID-19, Telemedicine, and Patient Empowerment in HIV Care and Research. AIDS Behav. 2020, 24, 1990–1993.
Massari, V.; Lapostolle, A.; Cadot, E.; Parizot, I.; Dray-Spira, R.; Chauvin, P. Gender, socio-economic status, migration origin and neighbourhood of residence are barriers to HIV testing in the Paris metropolitan area. AIDS Care 2011, 23 1609–1618
Maticka-Tyndale, E.; Adam, B.D.; Cohen, J.J. To work or not to work: Combination therapies and HIV. Health Res. 2002, 12, 1353–1372.
Rueda, S.; Raboud, J.; Rourke, S.B.; Bekele, T.; Bayoumi, A.; Lavis, J.; Cairney, J.; Mustard, C. Influence of employment and job security on physical and mental health in adults living with HIV: Cross-sectional analysis. Open Med. 2012, 6, e118–e126.
Rueda, S.; Smith, P.; Bekele, T.; O'Brien, K.; Husbands, W.; Li, A.; Jose-Boerbridge, M.; Mittmann, N.; Rachlis, A.; Conyers, L.; et al. Is any job better than no job? Labor market experiences and depressive symptoms in people living with HIV. AIDS Care 2015, 27, 907–915.
Ferrier, S.E.; Lavis, J.N. With health comes work? People living with HIV/AIDS consider returning to work. AIDS Care 2003, 15, 423–435.
Li, A.T.; Wales, J.; Wong, J.P.; Owino, M.; Perreault, Y.; Miao, A.; Maseko, P.; Guiang, C. Changing access to mental health care and social support when people living with HIV/AIDS become service providers. AIDS Care 2015, 27, 176–181.
Serrano, A. “How am I going to work?” Barriers to employment for immigrant Latinos and Latinas living with HIV in Toronto. Work 2015, 51, 365–372.

Prof. Dr. Liza M. Conyers
Dr. KB Boomer
Guest Editor

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Keywords

vocational rehabilitation
HIV
employment
prevention
health equity
social determinants of health

Published Papers (8 papers)

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Editorial

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4 pages, 225 KiB

Open AccessEditorial

Special Issue: Examining the Impacts of Social Determinants on HIV Health and Prevention

by K. B. Boomer

Int. J. Environ. Res. Public Health 2024, 21(1), 30; https://doi.org/10.3390/ijerph21010030 - 25 Dec 2023

Viewed by 1435

Abstract

Assessing the impact of social determinants of health (SDoH) has become an important part of the holistic view of an individual’s health status [...] Full article

(This article belongs to the Special Issue Social Determinants of HIV Health and Prevention)

Research

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14 pages, 1027 KiB

Open AccessArticle

Examining Cash Expenditures and Associated HIV-Related Behaviors Using Financial Diaries in Women Employed by Sex Work in Rural Uganda: Findings from the Kyaterekera Study

by Larissa Jennings Mayo-Wilson, Summer K. Peterson, Joshua Kiyingi, Proscovia Nabunya, Ozge Sensoy Bahar, Lyla S. Yang, Susan S. Witte and Fred M. Ssewamala

Int. J. Environ. Res. Public Health 2023, 20(9), 5612; https://doi.org/10.3390/ijerph20095612 - 23 Apr 2023

Viewed by 1647

Abstract

Background: Women employed by sex work (WESW) have a high risk of human immunodeficiency virus (HIV) infection and experience economic barriers in accessing care. However, few studies have described their financial lives and the relationship between expenditures and HIV-related behaviors. Methods: This exploratory study used financial diaries to collect expenditure and income data from WESW in Uganda over 6 months. Data were collected as part of a larger trial that tested the efficacy of an HIV prevention intervention method. Descriptive statistics were used to quantify women’s income, relative expenditures, and negative cash balances. Bivariate and multivariate logistic regressions were used to examine the odds of sexual risk behavior or use of HIV medications for several cash scenarios. Results: A total of 163 WESW were enrolled; the participants mean age was 32 years old. Sex work was the sole source of employment for most WESW (99%); their average monthly income was $62.32. Food accounted for the highest proportion of spending (44%) followed by sex work (20%) and housing expenditures (11%). WESW spent the least on health care (5%). Expenditures accounted for a large but variable proportion of these women’s income (56% to 101%). Most WESW (74%) experienced a negative cash balance. Some also reported high sex work (28%), health care (24%), and education (28%) costs. The prevalence of condomless sex (77%) and sex with drugs/alcohol (70%) was high compared to use of ART/PrEP (Antiretroviral therapy/Pre-exposure prophylaxis) medications (45%). Women’s cash expenditures were not statistically significantly associated with HIV-related behaviors. However, the exploratory study observed a consistent null trend of lower odds of condomless sex (adjusted odds ratio (AOR) = 0.70, 95% confidence interval (CI): 0.28–1.70), sex with drugs/alcohol (AOR = 0.93, 95% CI: 0.42–2.05), and use of ART/PrEP (AOR = 0.80, 95% CI: 0.39–1.67) among women who experienced a negative cash balance versus those who did not. Similar trends were observed for other cash scenarios. Conclusion: Financial diaries are a feasible tool to assess the economic lives of vulnerable women. Despite having paid work, most WESW encountered a myriad of financial challenges with limited spending on HIV prevention. Financial protections and additional income-generating activities may improve their status. More robust research is needed to understand the potentially complex relationship between income, expenditures, and HIV risk among vulnerable sex workers. Full article

(This article belongs to the Special Issue Social Determinants of HIV Health and Prevention)

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19 pages, 677 KiB

Open AccessArticle

Psychosocial and Health-Related Behavioral Outcomes of a Work Readiness HIV Peer Worker Training Program

by Erin McKinney-Prupis, Yung-Chen Jen Chiu, Christian Grov, Emma K. Tsui and Sharen I. Duke

Int. J. Environ. Res. Public Health 2023, 20(5), 4322; https://doi.org/10.3390/ijerph20054322 - 28 Feb 2023

Cited by 1 | Viewed by 1522

Abstract

Targeted work readiness training is an important approach to help people living with HIV (PLHIV) to overcome their unique barriers to work, while addressing social determinants of health needs. This study assesses the psychosocial impacts of a work readiness training and internship program among HIV peer workers in New York City. From 2014 through 2018, 137 PLHIV completed the training program, and 55 individuals completed both the training and the six-month peer internship. Depression, HIV internalized stigma, self-esteem, HIV medication adherence, patient self-advocacy, and safer sex communication apprehension were used as outcome measures. Paired t-tests were performed to determine if significant score changes occurred at the individual level before and after each training. Our results show that participating in the peer worker training program significantly decreased depression and internalized HIV stigma, and significantly increased self-esteem, medication adherence, and patient self-advocacy. The study underscores that peer worker training programs are important tools to improve not only the work readiness of PLHIV, but also psychosocial and health outcomes. Implications for HIV service providers and stakeholders are discussed. Full article

(This article belongs to the Special Issue Social Determinants of HIV Health and Prevention)

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16 pages, 828 KiB

Open AccessArticle

Measuring Phases of Employment Decision-Making and the Need for Vocational Services as a Social Determinant of the Health of Employed People Living with HIV

by KB Boomer, Liza M. Conyers, Yili Wang and Yung-Chen Jen Chiu

Int. J. Environ. Res. Public Health 2022, 19(22), 15074; https://doi.org/10.3390/ijerph192215074 - 16 Nov 2022

Cited by 1 | Viewed by 1150

Abstract

(1) Background: Secure employment has been recognized as a social determinant of health for people living with HIV (PLHIV), but limited research has been conducted to understand the employment needs and vocational decision-making process of those who are employed. The purpose of this study is to examine the applicability of the client-focused considering-work model to assess the employment outcomes and employment decision-making phases of a sample of employed PLHIV. (2) Methods: This study analyzed data of 244 employed PLHIV who completed National Working Positive Coalition’s Employment Needs Survey which included a 20-item Considering Work Scale-Employed version (CWS-Employed) and a single-item Classification of Employment Status Scale (CESS). Factor analysis was used to evaluate the CWS-Employed. Chi-square tests of homogeneity of proportions were conducted to assess the domain-specific needs of individuals in each phase of employment decision-making. (3) Results: Our findings revealed high rates of insecure employment and diverse vocational service needs among research participants. Additionally, the CWS-Employed accurately predicted 71% of the self-reported classification of phases of employment decision-making. (4) Conclusions: When investigating the role of employment as a social determinant of health, more research is needed to better understand the vocational needs and outcomes of PLHIV who are working. Improving the measurement of the phases of employment decision-making is needed to better identify appropriate vocational interventions that can lead to improved employment and related health outcomes for this population. Full article

(This article belongs to the Special Issue Social Determinants of HIV Health and Prevention)

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17 pages, 3138 KiB

Open AccessArticle

Examining the Implementation of Conditional Financial Incentives Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework to Improve HIV Outcomes among Persons Living with HIV (PLWH) in Louisiana

by Sarah Chrestman, Tejal Patel, Katherine Lass, Catherine Maulsby, Hayley Alexander, Charlie Schwanz, Kimberley O’Brien, Waref Azmeh, Austin Matthews, Latoya Decuir, Dionne Bell, Julie Cacioppo, Tina Martinez, Julie D. Doyle, Angie J. Brown, Shamekia Wave, Rubina Abrol, Tammeka Evans and Russell Brewer

Int. J. Environ. Res. Public Health 2022, 19(15), 9486; https://doi.org/10.3390/ijerph19159486 - 2 Aug 2022

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Abstract

Economic strengthening interventions are needed to support HIV outcomes among persons living with HIV (PLWH). The Baton Rouge Positive Pathway Study (BRPPS), a mixed method implementation science study, was conducted to assess key RE-AIM components tied to the provision of conditional financial incentives among PLWH in Baton Rouge, Louisiana. Seven hundred and eighty-one (781) PLWH enrolled at four HIV clinic sites were included in the final analyses. Participants completed an initial baseline survey, viral load test, and were contacted at 6 and 12 months (±1 month) post-enrollment for follow-up labs to monitor viral load levels. Participants received up to USD140 in conditional financial incentives. The primary analyses assessed whether participation in the BRPPS was associated with an increase in the proportion of participants who were: (a) engaged in care, (b) retained in care and (c) virally suppressed at baseline to 6 and 12 months post-baseline. We constructed a longitudinal regression model where participant-level outcomes at times t₀ (baseline) and t₁ (6- or 12-month follow-up) were modeled as a function of time. A secondary analysis was conducted using single-level regression to examine which baseline characteristics were associated with the outcomes of interest at 12-month follow-up. Cost analyses were also conducted with three of the participating clinics. Most participants identified as Black/African American (89%). Fewer than half of participants reported that they were unemployed or made less than USD5000 annually (43%). Over time, the proportion of participants engaged in care and retained in care significantly increased (70% to 93% and 32% to 64%, p < 0.00). However, the proportion of virally suppressed participants decreased over time (59% to 34%, p < 0.00). Implementation costs across the three sites ranged from USD17,198.05 to USD396,910.00 and were associated with between 0.37 and 1.34 HIV transmissions averted at each site. Study findings provide promising evidence to suggest that conditional financial incentives could help support engagement and retention in HIV care for a high need and at risk for falling out of HIV care population. Full article

(This article belongs to the Special Issue Social Determinants of HIV Health and Prevention)

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11 pages, 658 KiB

Open AccessArticle

Socioeconomic Status and the Sense of Coherence among Japanese People Living with HIV

by Taisuke Togari, Yoji Inoue, Gaku Oshima, Sakurako Abe, Rikuya Hosokawa and Yosuke Takaku

Int. J. Environ. Res. Public Health 2022, 19(13), 7673; https://doi.org/10.3390/ijerph19137673 - 23 Jun 2022

Cited by 2 | Viewed by 1670

Abstract

People living with HIV (PLWH) are forced to live with multiple and severe stressors. Focusing on sense of coherence (SOC), which is a concept of salutogenic and stress coping capacity, is useful in PLWH support. This study aimed to examine the association between SOC and socioeconomic status (SES) for Japanese PLWH. Methods: This study used data from the HIV Futures Japan national survey, which is an online survey with a cross-sectional design. This survey of PLWH in Japan was conducted from July 2013 to February 2014 and December 2016 to July 2017, resulting in 1422 valid responses. The mean age (SD) was 38.6 years (8.3). The 13-item SOC scale score was divided into two groups, based on Japanese standard score in a previous study, and logistic regression analysis was performed. Results: Education levels were indirectly associated with SOC through occupation. Compared to freelance-profession/self-employed, “unemployed job seekers” (OR [95%CI] = 2.16 [1.16, 4.04]) and “homemaker/recuperating/student” (2.09 [1.09, 4.02]) were directly related to poor SOC, regardless of income. Also, there is a clear SOC disparity in income (compared to “>8 million yen/year”, “<1 million yen/year” was 2.94 [1.46, 5.92], and “1–2.99 million yen/year” was 2.49 [1.33, 4.68]). Conclusion: It became clear that there is a relationship between SOC and SES. The results of this research provide important evidence for health promotion measures for PLWH. Full article

(This article belongs to the Special Issue Social Determinants of HIV Health and Prevention)

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Other

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19 pages, 930 KiB

Open AccessConcept Paper

Responding to the HIV Health Literacy Needs of Clients in Substance Use Treatment: The Role of Universal PrEP Education in HIV Health and Prevention

by Yusen Zhai, Kyesha M. Isadore, Lauren Parker and Jeremy Sandberg

Int. J. Environ. Res. Public Health 2023, 20(19), 6893; https://doi.org/10.3390/ijerph20196893 - 7 Oct 2023

Viewed by 1560

Abstract

Health literacy, particularly HIV health literacy, is a key social determinant of health and can be significantly improved through targeted health education. This paper explores the often-overlooked potential of pre-exposure prophylaxis (PrEP) education as a powerful tool to enhance HIV health literacy among people with substance use disorders (PWSUD), a population notably susceptible to HIV. Given the syndemic interplay of substance use disorders (SUDs) and HIV, health professionals, especially substance use counselors, are uniquely positioned to bolster HIV health literacy and positively influence health outcomes. This article offers a brief introduction to PrEP, delineates potential barriers and facilitators to its use and education, and proposes strategies for effective PrEP education, implementation, and adherence. By equipping substance use counselors with essential knowledge and skills, we aim to encourage and promote the integration of PrEP education into substance use treatment. The overarching objective is to empower counselors to proactively engage in HIV prevention efforts, thereby fulfilling pressing health literacy needs and contributing to improved health outcomes among PWSUD. Full article

(This article belongs to the Special Issue Social Determinants of HIV Health and Prevention)

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37 pages, 1730 KiB

Open AccessSystematic Review

The Role of the Social Determinants of Health on Engagement in Physical Activity or Exercise among Adults Living with HIV: A Scoping Review

by Farhana Safa, Natalia McClellan, Sarah Bonato, Sergio Rueda and Kelly K. O’Brien

Int. J. Environ. Res. Public Health 2022, 19(20), 13528; https://doi.org/10.3390/ijerph192013528 - 19 Oct 2022

Cited by 4 | Viewed by 2797

Abstract

Physical activity (PA) and exercise are an effective rehabilitation strategy to improve health outcomes among people living with HIV (PLWH). However, engagement in exercise among PLWH can vary. Our aim was to characterize the literature on the role of social determinants of health (SDOH) on engagement in PA or exercise among adults living with HIV. We conducted a scoping review using the Arksey and O’Malley Framework. We searched databases between 1996 and 2021. We included articles that examined PA or exercise among adults with HIV and addressed at least one SDOH from the Public Health Agency of Canada Framework. We extracted data from included articles onto a data extraction charting form, and collated results using content analytical techniques. Of the 11,060 citations, we included 41 articles, with 35 studies involving primary data collection 23 (66%) quantitative, 8 (23%) qualitative, and four (11%) mixed methods. Of the 14,835 participants, 6398 (43%) were women. Gender (n = 24 articles), social support (n = 15), and income and social status (n = 14) were the most commonly reported SDOH in the literature with the majority of studies addressing only one SDOH. Future research should consider the intersection between multiple SDOH to better understand their combined impact on engagement in PA or exercise among PLWH. Full article

(This article belongs to the Special Issue Social Determinants of HIV Health and Prevention)

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