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Silva MR, de Lima Bento J, de Aguiar Oliveira M, Fochat RC, Leite ICG, da Cruz Pereira GM. Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil. AIDS Behav 2024; 28:285-299. [PMID: 38087154 DOI: 10.1007/s10461-023-04220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/30/2023]
Abstract
Improvement in treatment options has increased the survival of people living with HIV (PLHIV). Thus, we evaluated the factors associated with better health-related quality of life (HRQoL) among PLHIV in Brazil. This was a cross-sectional study carried out among 349 PLHIV. Data were collected using an interview-based questionnaire, and HRQoL was assessed by the Brazilian version of the WHOQOL HIV BREF instrument. We used non-hierarchical cluster analysis (K-means) to compile the WHOQOL HIV BREF's overall and domain scores into a unique more multidimensional measure for HRQoL consisting of three clusters: poor, fair and good; associations with clusters of better HRQoL were assessed using multinomial logistic regression models. The mean and median overall HRQoL scores were 15.13 (SD = 3.39) and 16, respectively. The reliability and validity of the Brazilian version of the WHOQOL HIV BREF instrument was confirmed among PLHIV in a non-metropolitan, medium-sized municipality of Brazil, which reaffirmed the cross-cultural validity of this instrument. The factors male sex; heterosexual and asexual orientations; higher individual income; undetectable viral load; absence of any comorbidity and presence of an infectious or a chronic comorbidity, with mental illness as the reference; and never having consumed illegal substances were independently associated with good HRQoL. Thus, the compilation of the WHOQOL HIV BREF's overall and domain scores into a unique multidimensional measure for HRQoL, which this study proposed for the first time, may facilitate more robust interpretations and models of predictors. These differentials could simplify HRQoL as an indicator of health and wellbeing to be routinely used as a key outcome in the clinical management of patients and in the global monitoring of health system responses to HIV.
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Affiliation(s)
- Marcio Roberto Silva
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil.
- Embrapa Dairy Cattle, Brazilian Agricultural Research Company, Av. Eugênio do Nascimento, 610 - Aeroporto, Juiz de Fora, Minas Gerais, 36038-330, Brazil.
| | - Joseane de Lima Bento
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil
| | - Marina de Aguiar Oliveira
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil
- Doctor João Penido Regional Hospital, Hospital Foundation of the State of Minas Gerais, Juiz de Fora, Minas Gerais, 36048-000, Brazil
| | - Romário Costa Fochat
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil
- Faculty of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-900, Brazil
| | - Isabel Cristina Gonçalves Leite
- Postgraduate Program in Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-330, Brazil
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Rodríguez-Sánchez B, Peña-Longobardo LM, Oliva-Moreno J. The employment situation of people living with HIV: a closer look at the effects of the 2008 economic crisis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:485-497. [PMID: 34477995 DOI: 10.1007/s10198-021-01372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
This study aims to assess the determinants of employment probabilities among people living with Human Immunodeficiency Virus (HIV) during a 15-year period (2001-2016) in Spain, focusing on the possible effects of occurrences such as the 2008 economic crisis. The probability of people living with HIV having a job was evaluated by applying several multivariate probit regression models. Differences between the employment status of people living with HIV and that of the general population were evaluated by applying genetic matching regression models. With respect to the former evaluation, for people living with HIV, the period before the crisis (2001-2007) was associated with a probability of being employed that was 2.43 percentage points (p.p.) higher than during the crisis, and the period after the crisis (2014-2016) with a probability that was 7.58 p.p. lower than during the crisis. Greater effects were also observed among males, the probability of being in employment before the economic crisis being higher (by 2.26 p.p.) and lower after the crisis (- 3.41 p.p.) than among women, and among those infected through drug use (6.18 p.p. and - 7.34 p.p. before and after the crisis, respectively), than among those infected through sex. When analysing the differences with respect to the general population, people living with HIV reported lower probabilities of being employed: by - 18 p.p. before the crisis, by - 15 p.p. during the crisis (years 2008-2013) and by - 10 p.p. after the crisis, implying a convergence in the prospects of employment with the passage of the years. Those differences were greater for people of basic educational level (- 23 to - 16 p.p.), a weaker immune system (- 34 p.p. to - 21 p.p.) and those infected through the use of drugs (- 31 p.p. to - 26 p.p.). Although the results suggest that the economic crisis had a greater effect on the employment prospects of people living with HIV, and that effect is still felt by that group, our findings also point towards a convergence of their employment prospects with those of the general population, over the 15-year period assessed. An analysis of the employment situation of people living with HIV might have helped when designing job-seeking methods and policies on the working environment, especially through the 15-year period considered, when the economic crisis had a greater effect on the job market.
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Affiliation(s)
- Beatriz Rodríguez-Sánchez
- Faculty of Communication and Humanities, University Camilo José Cela, Urb. Villafranca del Castillo, Calle Castillo de Alarcón, 49Villanueva de la Cañada, 28692, Madrid, Spain.
| | - Luz María Peña-Longobardo
- Faculty of Law and Social Sciences, Economic Analysis and Finances Department, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Juan Oliva-Moreno
- Faculty of Law and Social Sciences, Economic Analysis and Finances Department, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
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Hopelessness and HIV infection: an exploratory study with a gender-specific perspective. BMC Psychol 2022; 10:46. [PMID: 35227317 PMCID: PMC8887031 DOI: 10.1186/s40359-022-00755-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background An understudied psychological response to HIV-related stressors among people living with HIV is hopelessness. Hopelessness is the expectation that things will not improve and feeling helpless to change one’s current situation. The aim of this study was to assess prevalence and levels of hopelessness and its direct and indirect contributors in people living with HIV in Sweden.
Methods Participants included 967 women and men from the “Living with HIV in Sweden” cross-sectional study with available data regarding hopelessness measured by the Beck Hopelessness Scale. Binary and multiple logistic regression analyses were used to determine direct and indirect factors that may contribute to feelings of hopelessness. Path analyses were used to assess the underlying structure of hopelessness. All analyses were conducted by gender. Results Almost half the participants reported moderate to severe hopelessness. There were no differences in frequency of feeling hopeless or level of hopelessness by gender or sexual orientation. Dissatisfaction with finances, dissatisfaction with physical health, and low HIV-related emotional support were found to be directly associated with hopelessness for both women and men. Although having some indirect factors in common, unemployment and HIV stigmatization, women and men had different underlying structures of hopelessness. Conclusions Our findings are important to HIV clinicians in identifying those at risk of hopelessness from a gender perspective in order to reduce preventable psychological distress among people living with HIV.
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Brouillette MJ, Koski L, Forcellino L, Gasparri J, Brew BJ, Fellows LK, Mayo NE, Cysique LA. Predicting occupational outcomes from neuropsychological test performance in older people with HIV. AIDS 2021; 35:1765-1774. [PMID: 33927088 DOI: 10.1097/qad.0000000000002927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The ability to work is amongst the top concerns of people living with well treated HIV. Cognitive impairment has been reported in many otherwise asymptomatic persons living with HIV and even mild impairment is associated with higher rates of occupational difficulties. There are several classification algorithms for HIV-associated neurocognitive disorder (HAND) as well as overall scoring methods available to summarize neuropsychological performance. We asked which method best explained work status and productivity. DESIGN Participants (N = 263) drawn from a longitudinal Canadian cohort underwent neuropsychological testing. METHODS : Several classification algorithms were applied to establish a HAND diagnosis and two summary measures (NPZ and Global Deficit Score) were computed. Self-reported work status and productivity was assessed at each study visit (four visits, 9 months apart). The association of work status with each diagnostic classification and summary measure was estimated using logistic regression. For those working, the value on the productivity scale was regressed within individuals over time, and the slopes were regressed on each neuropsychological outcome. RESULTS The application of different classification algorithms to the neuropsychological data resulted in rates of impairment that ranged from 28.5 to 78.7%. Being classified as impaired by any method was associated with a higher rate of unemployment. None of the diagnostic classifications or summary methods predicted productivity, at time of testing or over the following 36 months. CONCLUSION Neuropsychological diagnostic classifications and summary scores identified participants who were more likely to be unemployed, but none explained productivity. New methods of assessing cognition are required to inform optimal workforce engagement.
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Affiliation(s)
- Marie-Josée Brouillette
- Department of Psychiatry, McGill University
- Chronic Viral Illness Service, McGill University Health Centre (MUHC)
- Infectious Diseases and Immunity in Global Health Program, MUHC-RI, Montreal, QC
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, BC
| | - Lisa Koski
- Department of Psychology, McGill University
| | | | - Joséphine Gasparri
- Bachelor of Behavioral Neuroscience, Concordia University, Montreal, QC, Canada
| | - Bruce J Brew
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit
- Faculty of Medicine, University of Notre Dame, and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lesley K Fellows
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, BC
- Department of Neurology and Neurosurgery
- Montreal Neurological Hospital and Institute
| | - Nancy E Mayo
- Department of Medicine, School of Physical and Occupational Therapy, McGill University
- Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Center for Outcomes Research and Evaluation
- Division of Geriatrics, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Lucette A Cysique
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Chindarkar N, Kulkarni V, Chandwani R. Determinants of psychological well-being during the Covid-19 pandemic among "people living with HIV/AIDS" in India. AIDS Care 2021; 34:813-820. [PMID: 34383596 DOI: 10.1080/09540121.2021.1966696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACTUsing survey data on 647 "people living with HIV/AIDS" (PLHIV) respondents from India, we examine the association between human, economic, and social capital and psychological well-being during the Covid-19 pandemic, and whether pandemic-induced job and financial insecurity are significant stressors. We find that among human capital indicators, family health status results in a more positive mental state and fewer personal conflicts among PLHIV while having more working-age adults in the household results in more conflict. With regards to economic capital, PLHIV in salaried jobs and self-employment have a less positive mental state compared to those in daily wage work. Compared to daily wage workers, those in salaried jobs and self-employment exhibit lower addictive behavior. Self-employed PLHIV respondents also engage in fewer conflicts with their significant other. We do not find any correlation between social capital and psychological well-being. Job and financial insecurity are negatively associated with psychological well-being. While job insecurity is associated with an increase in addictive behavior, financial insecurity increases the likelihood of more frequent personal conflicts. We conclude that there is a need for greater economic and psychological support from institutions, community, and family to assuage the pandemic-induced psychological distress among PLHIV.ABBREVIATIONS: ART: antiretroviral treatment; GSNP+: Gujarat State Network of Positive People; MHI: mental health inventory; OBC: other backward castes; PLHIV: people living with HIV/AIDS; SC: scheduled castes; SD: standard deviation; ST: scheduled tribes.
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Carlander C, Wagner P, Yilmaz A, Sparén P, Svedhem V. Employment by HIV status, mode of HIV transmission and migrant status: a nation-wide population-based study. AIDS 2021; 35:115-123. [PMID: 33048876 DOI: 10.1097/qad.0000000000002724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare employment in people by HIV status, mode of HIV transmission and migrant status. DESIGN Nation-wide population-based register data from 1996 to 2016. METHODS All people born between 1940 and 2000 (n = 8587 629) were identified from the Swedish Total Population Register and linked to the Swedish National HIV Register (n = 9492) and Longitudinal Integration Database for Health Insurance and Labour Market Studies. Adjusted prevalence ratios (adjPR) of employment were calculated using Poisson regression. Trends in employment were illustrated in scatterplots with overlaid prediction plots. RESULTS People with HIV were less likely employed than HIV-negative but with decreasing difference over time [adjPR 0.57, 95% confidence interval (CI) 0.54-0.60 in 1996, adjPR 0.84, 95% CI 0.83-0.86 in 2016]. Female migrants with HIV had the highest increase of employment over time and were more likely employed than HIV-negative female migrants by end of follow-up (adjPR 1.12, 95% CI 1.08-1.16). Swedish-born with present/former intravenous drug use had the lowest employment rates. Individuals with undetectable HIV-RNA viral levels showed higher employment rates (adjPR 1.29, 95% CI 1.20-1.38) compared with those with detectable viral levels. CONCLUSION Employment in people living with HIV (PLWH) increased over time but remained lower than for HIV-negative people. HIV was not associated with lower employment in migrants by end of follow-up, indicating that HIV is not a barrier for employment among migrants in Sweden. The heterogeneity of PLWH needs to be taken into account in interventions, and future studies, focusing on access to the labour market in PLWH.
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Affiliation(s)
- Christina Carlander
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Philippe Wagner
- Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Veronica Svedhem
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Wise JM, Vance DE, Heaton K, Raper JL, Konkle-Parker D, Azuero A, Kempf MC. Employment and Occupational Productivity Among Women Living With HIV: A Conceptual Framework. J Assoc Nurses AIDS Care 2021; 32:37-46. [PMID: 32852297 DOI: 10.1097/jnc.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
ABSTRACT Women living with HIV (WLWH) have lower employment rates and more difficulty finding and keeping employment compared with their counterparts without HIV. These disparities affect physical, psychological, and socioeconomic outcomes, and they may compound the disadvantages associated with living with HIV. Although historical literature has emphasized the impact of clinical factors on employment, current evidence suggests that socioeconomic and psychosocial factors associated with HIV should be included for a more comprehensive view. Based on this broader inclusion, a conceptual framework is presented describing how socioeconomic and psychosocial characteristics influence employment acquisition and maintenance among WLWH. The framework posits that there is a reciprocal relationship between employment acquisition and occupational productivity, and psychological health, physical health, social support, and empowerment. Implications for future research and interventions include (a) an extended conceptualization of vocational rehabilitation and (b) the use of peer support groups to increase social capital, empowerment, knowledge, and resources among WLWH.
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Affiliation(s)
- Jenni M Wise
- Jenni M. Wise, PhD, MSN, RN, is an Assistant Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, is the Associate Dean for Research and Scholarship, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Karen Heaton, PhD, FNP-BC, FAAN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. James L. Raper, PhD, CRNP, JD, FAANP, FAAN, is a Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Deborah Konkle-Parker, PhD, FNP, FAAN, is a Professor, Department of Medicine, Department of Infectious Diseases, and School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA. Andres Azuero, PhD, is the Director of Statistics, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Mirjam-Colette Kempf, PhD, MPH, is a Professor, School of Nursing, School of Medicine, and School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Yu Y, Chen Z, Huang S, Chen Z, Zhang K. What determines employment quality among people living with HIV: An empirical study in China. PLoS One 2020; 15:e0243069. [PMID: 33259563 PMCID: PMC7707494 DOI: 10.1371/journal.pone.0243069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/14/2020] [Indexed: 11/18/2022] Open
Abstract
At the intersection of research areas on health and employment, little attention has been paid on employment quality among people living with HIV (PLWH). The objective of the current study is to identify critical factors and empirically examine their effects on employment quality among PLWH. Based on the social-ecological perspective, we identified negative self-image, workplace discrimination, social support, and policy support as critical factors associated with employment quality among PLWH. Thereafter, a questionnaire survey was conducted to gather information from 339 employed PLWH in China. Hierarchical regression analyses were further performed to analyze the effects of the identified factors on employment quality among PLWH. We obtained three main findings. First, negative self-image and workplace discrimination are detrimental to employment quality among PLWH; whereas social support and policy support are conducive to their employment quality. Second, older, male, and highly educated PLWH can better leverage the undesirable effects of negative self-image and workplace discrimination on employment quality compared with their peers. Third, male, and highly educated PLWH can better utilize social support and policy support to advance employment quality compared with their peers. However, the employment quality effects of the identified factors did not differ by marital status. Our findings provided some useful implications for PLWH, employers, community service providers, and policy makers to promote employment quality among PLWH.
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Affiliation(s)
- Yunjiang Yu
- School of International Economics and Trade, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Zhi Chen
- School of Business Administration, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Shenglan Huang
- School of Business Administration, Shanghai Lixin University of Accounting and Finance, Shanghai, China
- * E-mail:
| | - Zhicheng Chen
- School of Business Administration, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Kailin Zhang
- School of Finance, Shanghai Lixin University of Accounting and Finance, Shanghai, China
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Abstract
Employment is a social determinant of health that is important for understanding health behaviors, health outcomes and HIV transmission among people living with HIV. This study is a scoping review of the literature that addresses (a) the relationship between employment and the HIV continuum of care, (b) determinants of employment among PLWH and (c) experiences with employment. We searched two databases, PubMed and Embase, and identified a total of 5622 articles that were subjected to title and abstract review. Of these, 5387 were excluded, leaving 235 articles for full-text review. A total of 66 articles met inclusion criteria and were included in the study. The literature suggests that employment status is positively associated with HIV testing, linkage to HIV care, retention in HIV care, and HIV medication adherence. Guided by a social-ecological framework, we identified determinants of employment at the individual, interpersonal, organizational, community, and policy levels that are amenable to public health intervention. Experiences with employment, including barriers, facilitators, advantages, disadvantages, and needs, provide additional insight for future research and programs.
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Affiliation(s)
- Catherine H Maulsby
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Rm. 904C, Baltimore, MD, 21205, USA.
| | - Aneeka Ratnayake
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donna Hesson
- Welch Medical Library, Johns Hopkins University, Baltimore, MD, USA
| | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Özdemir HÖ, Tosun S, Özdemir D, Korkmaz E. The determinants of employability of people living with HIV/AIDS in Turkey. Am J Ind Med 2020; 63:92-98. [PMID: 31691331 DOI: 10.1002/ajim.23056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study addresses an important field within HIV research, the factors affecting the determinants of the employability of people living with HIV/AIDS (PLHIV) in Turkey. The employability of PLHIV is now even more vital because the use of antiretroviral therapy improves the quality of life of patients. In spite of this, the related literature suggests that there are serious impediments to the employment of PLHIV who face considerable levels of discrimination based on their HIV status. METHODS This is a cohort study of 170 PLHIV of working age, treated at the Izmir Bozyaka Education and Training Hospital. We use a univariate logistic model to determine the effects of all determinants of interest with probit/logit modeling and penalized maximum likelihood estimation to avoid bias and to test the robustness of results. RESULTS Age, time since diagnosis, work status at diagnosis, wealth status, illicit drug use, and CD4 cell count were significantly related to the employability of PLHIV. Younger individuals had a higher probability of workforce participation. HIV-infected patients aged 19 to 39 and 40 to 54 years were 32% and 20% more likely, respectively, to be employed. Economically better-off PLHIV were more likely to participate in the labor force and HIV patients who were working at the time of diagnosis were more likely to be re-employed. Time since diagnosis was negatively associated with the employment status. Compared to recently diagnosed patients, PLHIV for more than a decade were less likely to be employed. Those with high CD4 cell counts were more likely to be employed. Illicit drug use was negatively associated with employment and drug-addicted HIV patients were less likely to be employed. Higher education did not significantly predict the employability of PLHIV. CONCLUSIONS Our results suggest that besides immunological status, socioeconomic factors play a substantial role in the employability of PLHIV. We suggest that even if a patient is skilled, educated, and qualified for the job, other factors such as stigma and employment discrimination in the workplace may hinder employment even among highly educated PLHIV.
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Affiliation(s)
- Hülya Özkan Özdemir
- Department of Clinical Microbiology and Infectious Diseases, Bozyaka Education and Research HospitalUniversity of Health Sciencesİzmir Turkey
| | - Selma Tosun
- Department of Clinical Microbiology and Infectious Diseases, Bozyaka Education and Research HospitalUniversity of Health Sciencesİzmir Turkey
| | | | - Elif Korkmaz
- Department of EconomicsEge Universityİzmir Turkey
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Zeng C, Guo Y, Hong YA, Gentz S, Zhang J, Zhang H, Qiao J, Xu Z, Cai W. Differential effects of unemployment on depression in people living with HIV/AIDS: a quantile regression approach. AIDS Care 2019; 31:1412-1419. [PMID: 30835499 DOI: 10.1080/09540121.2019.1587366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Unemployment is associated with depression in people living with HIV (PLWH). However, few studies have examined the effects of unemployment on PLWH with different levels of depression. The current study explores the plausible differential effects of unemployment on the different percentiles of depression in PLWH employing a quantile regression (QR) approach, based on a recent survey of 411 PLWH in China. Among participants, 47.7% had elevated depressive symptoms, and 23.8% were unemployed. The effects of unemployment on depression were statistically significant with a trend of initial increase followed by a decline at the quantile levels of 0.51-0.90 of depression. The maximum effect of unemployment status on depression was statistically significant at the 70th and 75th percentiles of depression (coefficient = 7.0, p < .01). Tailored strategies and interventions should be implemented to address the differential needs of PLWH with various levels of depressive symptoms.
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Affiliation(s)
- Chengbo Zeng
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Yan Guo
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University , Guangzhou , People's Republic of China.,Sun Yat-Sen Center for Migrant Health Policy , Guangzhou , People's Republic of China.,Sun Yat-Sen Center for Global Health , Guangzhou , People's Republic of China
| | - Y Alicia Hong
- School of Public Health, Texas A&M University , College Station , TX , USA
| | - Shelene Gentz
- Department of Human Science, University of Namibia , Windhoek , Namibia
| | - Jinxin Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Hanxi Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Jiaying Qiao
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Zhimeng Xu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Weiping Cai
- Department of Infectious Diseases, Guangzhou Number Eight People's Hospital , Guangzhou , People's Republic of China
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Vance DE, Blake BJ, Brennan-Ing M, DeMarco RF, Fazeli PL, Relf MV. Revisiting Successful Aging With HIV Through a Revised Biopsychosocial Model: An Update of the Literature. J Assoc Nurses AIDS Care 2019; 30:5-14. [PMID: 30586079 DOI: 10.1097/jnc.0000000000000029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The concept of successful aging was recognized only recently by HIV researchers because people living with HIV (PLWH) in the early epidemic were not expected to survive. With the introduction of antiretrovirals that block viral replication, PLWH are now aging with HIV. Given the complex nature of HIV within the social, economic, and political climates in which it occurs, a holistic model of successful aging is needed to guide researchers and clinicians. Several overarching models exist, but must be updated for rapidly advancing HIV and aging research agendas. We provide an updated, adapted, and integrated biopsychosocial model of successful aging with HIV based on the principles of Baltes and Baltes (1998) on 8 essential components of successful aging: (a) length of life, (b) biological health, (c) mental health, (d) cognitive efficiency, (e) social competence, (f) productivity, (g) personal control, and (h) life satisfaction. Clinical practice and research implications are highlighted.
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van Opstal SEM, van der Zwan JS, Wagener MN, Been SK, Miedema HS, Roelofs PDDM, van Gorp ECM. Late Presentation of HIV Infection in the Netherlands: Reasons for Late Diagnoses and Impact on Vocational Functioning. AIDS Behav 2018; 22:2593-2603. [PMID: 29550940 PMCID: PMC6097719 DOI: 10.1007/s10461-018-2082-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Late diagnosis of HIV remains a major challenge in the HIV epidemic. In Europe, about 50% of all people living with HIV are diagnosed late after infection has occurred. Insight into the reasons for late diagnoses is necessary to increase the number of early diagnoses and optimize treatment options. This qualitative study explored the experiences of 34 late-presenters through in-depth semi-structured interviews. A variety of reasons for late diagnoses emerged from our data and led to a division into four groups, characterized by two dimensions. Regarding vocational functioning, the consequences of late diagnoses were health-related problems prior to and since diagnosis, and problems concealing the HIV status. Healthcare providers should offer HIV tests to groups at risk, and be alert for clinical HIV indicator conditions. It is recommended to increase awareness of HIV transmission routes, symptoms and tests, and the benefits of early testing and early entry to HIV care.
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Affiliation(s)
- S E M van Opstal
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands.
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - J S van der Zwan
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - M N Wagener
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - S K Been
- Erasmus MC, Department of Internal Medicine and Infectious Diseases, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H S Miedema
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - P D D M Roelofs
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - E C M van Gorp
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands
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14
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Verbooy K, Wagener M, Kaddouri M, Roelofs P, Miedema H, van Gorp E, Brouwer W, van Exel J. Are people living with HIV less productive at work? AIDS Care 2018. [PMID: 29517931 DOI: 10.1080/09540121.2018.1447076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Health problems may cause decreased productivity among working people. It is unclear if this also applies for people living with HIV (PLWH). This cross-sectional study compares data of PLWH of one of the main HIV treatment centres in the Netherlands (n = 298) to data of the general working population from a previously conducted study (n = 986). We investigate whether productivity at work differs between these groups. The questionnaires used in these studies contained a core of identical questions regarding productivity losses, in the form of absenteeism and presenteeism, over a four-week period and a variety of baseline characteristics, including health status measured with EQ-5D. For PLWH additional clinical data were collected from patient records. From the data, descriptive statistics were computed to characterize the samples. Pearson correlations were used to explore significant associations of productivity with baseline characteristics. A two-part model was used to evaluate both the occurrence and of size of productivity losses in working PLWH and an aggregated sample of PLWH and the general population. It was observed that, on average, total productivity losses do not differ significantly between working PWLH and the general working population, but that the occurrence and size of absenteeism and presenteeism were different. Furthermore, more health problems were associated with higher productivity losses. HIV status was not significantly associated with productivity losses. We conclude that among working people, health status was related to productivity losses but HIV status was not. However, further research is needed into the relation between HIV status and unemployment.
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Affiliation(s)
- Kaya Verbooy
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Marlies Wagener
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands.,c Department of Viroscience , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Meriam Kaddouri
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Pepijn Roelofs
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands
| | - Harald Miedema
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands
| | - Eric van Gorp
- c Department of Viroscience , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands.,d Department of Internal Medicine , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Werner Brouwer
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Job van Exel
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands.,e Erasmus School of Economics , Erasmus University Rotterdam , Rotterdam , the Netherlands
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