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Souleymanov R, Still M, Christianson T, Morris M, Favel A, Wahpoosewyan D, McLeod A, Gervais L, King A, Piyesis MK, Jackson R, Payne M, Ringaert L, Larcombe L, Restall G, Montpetit D. The Gigii-Bapiimin Study: resilience and the impacts of COVID-19 on health and wellbeing of Indigenous people living with HIV in Manitoba and Saskatchewan. AIDS Care 2024; 36:899-907. [PMID: 38843558 DOI: 10.1080/09540121.2024.2361827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/24/2024] [Indexed: 07/25/2024]
Abstract
The Gigii-Bapiimin study explored the impacts of the COVID-19 pandemic on the health and wellbeing of First Nations, Inuit, and Métis people living with HIV in Manitoba and Saskatchewan, two provinces in Canada with alarmingly high rates of HIV infections. Participants (n = 28 in Manitoba and n = 23 in Saskatchewan) were recruited using various methods, including flyers, community organizations, peers, and social media. The qualitative interviews focused on the pandemic's impact on health, access to services, and ceremonies. The data were analyzed using inductive thematic analysis. The study identified three key themes: (a) resilience and coping; (b) negative impacts on health and substance use; (c) decreased access to health services, HIV care and harm reduction. The participants shared their experiences of social isolation and the loss of community support, which had deleterious effects on their mental health and substance use. The impacts on access to HIV care were exacerbated by poverty, homelessness, and distress over inadvertent disclosure of HIV status. Participants mitigated these impacts by relying on Indigenous knowledges, ceremonies, and resilience within their communities. Service providers must address the impacts of the COVID-19 pandemic on Indigenous people living with HIV and their access to HIV services and ceremonies.
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Affiliation(s)
- Rusty Souleymanov
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
| | - Marni Still
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
| | | | - Melissa Morris
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
| | - Ann Favel
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
| | | | - Albert McLeod
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
- Two-Spirit Consultants Inc., Winnipeg, Canada
| | | | - Alexandra King
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Randy Jackson
- School of Social Work, McMaster University, Hamilton, Canada
| | - Mike Payne
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
- Nine Circles Community Health Centre, Winnipeg, Canada
| | - Laurie Ringaert
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
| | - Linda Larcombe
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
| | - Gayle Restall
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
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Abstract
Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages.
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Benoit AC, Younger J, Beaver K, Jackson R, Loutfy M, Masching R, Nobis T, Nowgesic E, O'Brien-Teengs D, Whitebird W, Zoccole A, Hull M, Jaworsky D, Benson E, Rachlis A, Rourke SB, Burchell AN, Cooper C, Hogg RS, Klein MB, Machouf N, Montaner JSG, Tsoukas C, Raboud J. Increased mortality among Indigenous persons in a multisite cohort of people living with HIV in Canada. Canadian Journal of Public Health 2017. [PMID: 28621653 DOI: 10.17269/cjph.108.5708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Compare all-cause mortality between Indigenous participants and participants of other ethnicities living with HIV initiating combination antiretroviral therapy (cART) in an interprovincial multi-site cohort. METHODS The Canadian Observational Cohort is a collaboration of 8 cohorts of treatment-naïve persons with HIV initiating cART after January 1, 2000. Participants were followed from the cART initiation date until death or last viral load (VL) test date on or before December 31, 2012. Cox proportional hazard models were used to estimate the effect of ethnicity on time until death after adjusting for age, gender, injection drug use, being a man who has sex with men, hepatitis C, province of origin, baseline VL and CD4 count, year of cART initiation and class of antiretroviral medication. RESULTS The study sample consisted of 7080 participants (497 Indigenous, 2471 Caucasian, 787 African/Caribbean/Black (ACB), 629 other, and 2696 unknown ethnicity). Most Indigenous persons were from British Columbia (BC) (83%), with smaller numbers from Ontario (13%) and Québec (4%). During the study period, 714 (10%) participants died. The five-year survival probability was lower for Indigenous persons (0.77) than for Caucasian (0.94), ACB (0.98), other ethnicities (0.96) and unknown ethnicities (0.85) (p < 0.0001). In an adjusted proportional hazard model for which missing data were imputed, Indigenous persons were more likely to die than Caucasian participants (hazard ratio = 2.69, p < 0.0001). CONCLUSION The mortality rate for Indigenous persons was higher than for other ethnicities and is largely reflective of the BC population. Addressing treatment challenges and identifying HIV- and non-HIV-related causes for mortality among Indigenous persons is required to optimize their clinical management.
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Affiliation(s)
- Anita C Benoit
- Women's College Research Institute, Women's College Hospital, Toronto, ON; Building Bridges Team, Toronto, ON and/or Vancouver, BC.
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The adherence gap: a longitudinal examination of men's and women's antiretroviral therapy adherence in British Columbia, 2000-2014. AIDS 2017; 31:827-833. [PMID: 28272135 DOI: 10.1097/qad.0000000000001408] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to observe the effect of sex on attaining optimal adherence to combination antiretroviral therapy (cART) longitudinally while controlling for known adherence confounders - IDU and ethnicity. DESIGN Using the population-based HAART Observational Medical Evaluation and Research cohort, data were collected from HIV-positive adults, aged at least 19 years, receiving cART in British Columbia, Canada, with data collected between 2000 and 2014. cART adherence was assessed using pharmacy refill data. The proportion of participants reaching optimal (≥95%) adherence by sex was compared per 6-month period from initiation of therapy onward. Generalized linear mixed models with logistic regression examined the effect of sex on cART adherence. RESULTS Among 4534 individuals followed for a median of 65.9 months (interquartile range: 37.0-103.2), 904 (19.9%) were women, 589 (13.0%) were Indigenous, and 1603 (35.4%) had a history of IDU. A significantly lower proportion of women relative to men were optimally adherent overall (57.0 vs. 77.1%; P < 0.001) and in covariate analyses. In adjusted analyses, female sex remained independently associated with suboptimal adherence overall (adjusted odds ratio: 0.55; 95% confidence interval: 0.48-0.63). CONCLUSION Women living with HIV had significantly lower cART adherence rates then men across a 14-year period overall, and by subgroup. Targeted research is required to identify barriers to adherence among women living with HIV to tailor women-centered HIV care and treatment support services.
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Benoit AC, Younger J, Beaver K, Jackson R, Loutfy M, Masching R, Nobis T, Nowgesic E, O'Brien-Teengs D, Whitebird W, Zoccole A, Hull M, Jaworsky D, Rachlis A, Rourke S, Burchell AN, Cooper C, Hogg R, Klein MB, Machouf N, Montaner J, Tsoukas C, Raboud J. A comparison of virological suppression and rebound between Indigenous and non-Indigenous persons initiating combination antiretroviral therapy in a multisite cohort of individuals living with HIV in Canada. Antivir Ther 2016; 22:325-335. [PMID: 27925609 DOI: 10.3851/imp3114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study compared time to virological suppression and rebound between Indigenous and non-Indigenous individuals living with HIV in Canada initiating combination antiretroviral therapy (cART). METHODS Data were from the Canadian Observational Cohort collaboration; eight studies of treatment-naive persons with HIV initiating cART after 1/1/2000. Fine and Gray models were used to estimate the effect of ethnicity on time to virological suppression (two consecutive viral loads [VLs] <50 copies/ml at least 3 months apart) after adjusting for the competing risk of death and time until virological rebound (two consecutive VLs >200 copies/ml at least 3 months apart) following suppression. RESULTS Among 7,080 participants were 497 Indigenous persons of whom 413 (83%) were from British Columbia. The cumulative incidence of suppression 1 year after cART initiation was 54% for Indigenous persons, 77% for Caucasian and 80% for African, Caribbean or Black (ACB) persons. The cumulative incidence of rebound 1 year after suppression was 13% for Indigenous persons, 6% for Caucasian and 7% for ACB persons. Indigenous persons were less likely to achieve suppression than Caucasian participants (aHR=0.58, 95% CI 0.50, 0.68), but not more likely to experience rebound (aHR=1.03, 95% CI 0.84, 1.27) after adjusting for age, gender, injection drug use, men having sex with men status, province of residence, baseline VL and CD4+ T-cell count, antiretroviral class and year of cART initiation. CONCLUSIONS Lower suppression rates among Indigenous persons suggest a need for targeted interventions to improve HIV health outcomes during the first year of treatment when suppression is usually achieved.
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Affiliation(s)
- Anita C Benoit
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Building Bridges Team, Toronto, ON & Vancouver, BC, Canada
| | - Jaime Younger
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | | | - Randy Jackson
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,McMaster University, Hamilton, ON, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Maple Leaf Medical Clinic, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Renée Masching
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Canadian Aboriginal AIDS Network, Dartmouth, NS, Canada
| | - Tony Nobis
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Ontario Aboriginal HIV/AIDS Strategy, Toronto, ON, Canada
| | - Earl Nowgesic
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Doe O'Brien-Teengs
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Lakehead University, Thunder Bay, ON, Canada
| | - Wanda Whitebird
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Ontario Aboriginal HIV/AIDS Strategy, Toronto, ON, Canada
| | - Art Zoccole
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,2-Spirited People of the 1st Nations, Toronto, ON, Canada
| | - Mark Hull
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Denise Jaworsky
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Sean Rourke
- Ontario HIV Treatment Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, ON, Canada.,Department of Psychiatry, St Michael's Hospital, Toronto, ON, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.,Centre for Urban Health Solutions, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Curtis Cooper
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Hogg
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Marina B Klein
- Department of Medicine, McGill University Health Centre Research Institute, Montréal, QC, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Nima Machouf
- Clinique Médicale L'Actuel, Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Tsoukas
- Experimental Medicine, McGill University, Montréal, QC, Canada
| | - Janet Raboud
- Building Bridges Team, Toronto, ON & Vancouver, BC, Canada.,Toronto General Research Institute, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Improvements in HIV treatment outcomes among indigenous and non-indigenous people who use illicit drugs in a Canadian setting. J Int AIDS Soc 2016; 19:20617. [PMID: 27094914 PMCID: PMC4837333 DOI: 10.7448/ias.19.1.20617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/03/2016] [Accepted: 03/02/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In many settings worldwide, members of indigenous groups experience a disproportionate burden of HIV. In Canada, there is an urgent need to improve HIV treatment outcomes for indigenous people living with HIV (IPLWH), to not only reduce HIV/AIDS-associated morbidity and mortality but also curb elevated rates of viral transmission. Thus, by comparing indigenous and non-indigenous participants in an ongoing longitudinal cohort of HIV-positive people who use illicit drugs, we sought to investigate longitudinal changes in three HIV treatment indicators for IPLWH who use illicit drugs during a community-wide treatment-as-prevention (TasP) initiative in British Columbia, Canada. METHODS We used data from the ACCESS study, an ongoing observational prospective cohort of HIV-positive illicit drug users recruited from community settings in Vancouver, British Columbia. Cohort data are linked to comprehensive retrospective and prospective clinical records in a setting of no-cost HIV/AIDS treatment and care. We used multivariable generalized estimating equations (GEE) to evaluate longitudinal changes in the proportion of participants with exposure to antiretroviral therapy (ART) in the previous 180 days, optimal adherence to ART (i.e. ≥ 95% vs. < 95%) and non-detectable HIV-1 RNA viral load (VL <50 copies/mL plasma). RESULTS Between 2005 and 2014, 845 individuals were recruited, including 326 (39%) self-reporting any indigenous ancestry, and contributed 6732 interviews and 13,495 VL measurements. Among indigenous participants, the proportion with recent ART increased from 51 to 94% and non-detectable VL from 23 to 65%. In multivariable models, later interview period was positively associated with recent ART (adjusted odds ratio (AOR) = 1.16 per interview period, 95% confidence interval (CI): 1.11 to 1.20) and non-detectable VL (AOR = 1.07, 95% CI: 1.04 to 1.10). In adjusted models comparing indigenous and non-indigenous participants, we did not observe differences between the two groups (all p>0.1). CONCLUSIONS In this large and long-term study involving community-recruited HIV-positive illicit drug users, we observed a substantial and increasing proportion of indigenous participants reach several important thresholds in HIV care at rates indistinguishable from non-indigenous participants. The current findings highlight the important role of TasP on vulnerable populations in this setting and contribute to the evidence base supporting the immediate scale-up of ART to address HIV/AIDS-associated morbidity, mortality and viral transmission.
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Negin J, Aspin C, Gadsden T, Reading C. HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav 2015; 19:1720-34. [PMID: 25731659 PMCID: PMC4551545 DOI: 10.1007/s10461-015-1023-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia,
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Lefebvre ME, Hughes CA, Yasui Y, Saunders LD, Houston S. Antiretroviral treatment outcomes among foreign-born and Aboriginal peoples living with HIV/AIDS in northern Alberta. Canadian Journal of Public Health 2014; 105:e251-7. [PMID: 25166126 DOI: 10.17269/cjph.105.4254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 07/23/2014] [Accepted: 06/22/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The HIV/AIDS epidemic disproportionately involves socially vulnerable populations. Since 2001, the proportion of foreign-born patients served by the Northern Alberta HIV Program has increased. Our study aimed to evaluate antiretroviral therapy (ART) outcomes among HIV-infected foreign-born patients in northern Alberta, Canada, prescribed once-daily ART. METHODS We utilized a two-part retrospective cohort study to compare ART outcomes of foreign-born and Canadian-born Aboriginal patients compared to Canadian-born non-Aboriginal patients. Part 1 utilized logistic regression to compare the odds of experiencing initial virological suppression of foreign-born (40%) and Canadian-born Aboriginal patients (27%) compared with Canadian-born non-Aboriginal patients (33%). Part 2 used survival analysis to compare the rate of ART failure by country of origin among patients who achieved initial virological suppression in Part 1. RESULTS Our study sample included 322 treatment-naïve patients (122 foreign-born). For Part 1, 261 patients achieved initial virological suppression within six months of initiating ART. After controlling for age, treatment regimen, HIV risk exposure, and calendar year compared to Canadian-born non-Aboriginal patients, the odds of achieving initial virological suppression were significantly lower for Canadian-born Aboriginal patients (OR=0.44, 95% CI: 0.20-0.96); and similar for foreign-born patients (OR=0.76, 95% CI: 0.33-1.73). Part 2 included 261 patients who were followed for 635.1 person-years. Adjusting for age, sex, baseline CD4 cell count, and drug regimen, compared to Canadian-born non-Aboriginal patients, Canadian-born Aboriginal and foreign-born patients had similar rates of virological failure after achieving initial virological suppression (HR=1.54, 95% CI: 0.38-6.18; HR=0.49, 95% CI: 0.11-2.20, respectively). CONCLUSIONS Our study indicated that ART outcomes among Alberta-based foreign-born patients are similar to those among Canadian-born non-Aboriginal patients. Our results, however, suggested that Canadian-born Aboriginal patients had poorer treatment outcomes compared to Canadian-born non-Aboriginal patients. It is imperative, therefore, that clinicians, researchers and community members better understand reasons for poor ART outcomes among Canadian-born Aboriginal patients in northern Alberta.
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Ti L, Milloy MJ, Shannon K, Simo A, Hogg RS, Guillemi S, Montaner J, Kerr T, Wood E. Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting: an observational cohort study. Sex Transm Infect 2014; 90:418-22. [PMID: 24523347 DOI: 10.1136/sextrans-2013-051408] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Studies have demonstrated the central function of plasma HIV-1 RNA viral load (pVL) levels on determining the risk of HIV disease progression and transmission. However, there is limited empirical research on virologic outcomes among sex workers who use illicit drugs (SW-DU). METHODS Data were derived from the AIDS Care Cohort to evaluate Exposure to Survival Services, a cohort of HIV-positive illicit drug users. Using generalised estimating equations, we studied the longitudinal relationship between sex work and pVL suppression. We also tested whether adherence to antiretroviral therapy (ART) mediated the relationship between sex work and pVL suppression. RESULTS Between May 1996 and May 2012, 587 ART-exposed participants (2224 person-years of observation) were included in the study, among whom 127 (21.6%) reported sex work. In a time-updated multivariate model adjusted for various demographic, socioeconomic and clinical confounders (eg, gender, incarceration, CD4 cell count), SW-DU had an independently reduced odds of pVL suppression compared to non-SW-DU (adjusted OR (AOR)=0.66; 95% CI 0.45 to 0.96). However, adding ART adherence to the multivariate model eliminated this association (p>0.05), suggesting adherence mediated the relationship between sex work and pVL suppression. CONCLUSIONS Evidence-based interventions to improve adherence to ART among SW-DU are urgently needed to help produce the maximum HIV treatment and prevention benefit of ART among this highly vulnerable population.
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Affiliation(s)
- Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annick Simo
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sylvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Cain R, Jackson R, Prentice T, Collins E, Mill J, Barlow K. The experience of HIV diagnosis among Aboriginal people living with HIV/AIDS and depression. QUALITATIVE HEALTH RESEARCH 2013; 23:815-824. [PMID: 23539094 DOI: 10.1177/1049732313482525] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this article, we consider how the broad context of Aboriginal people's lives can shape their experience and understanding of their HIV diagnosis. We conducted interviews across Canada with 72 Aboriginal people living with HIV who also reported feelings of depression. Consistent with what has been found in previous studies, participants responded to their HIV diagnosis with shock, disbelief, and often anger. Prior depression, drug and alcohol use, multiple losses, stigma, and social isolation also shaped how participants experienced their diagnosis. We consider how the history of colonization of Aboriginal communities in Canada relates to the experience of HIV diagnosis, and end with a discussion of the service implications of our findings.
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Affiliation(s)
- Roy Cain
- School of Social Work (KTH-312), McMaster University, Hamilton, Ontario, Canada.
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11
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Tu D, Belda P, Littlejohn D, Pedersen JS, Valle-Rivera J, Tyndall M. Adoption of the chronic care model to improve HIV care: in a marginalized, largely aboriginal population. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:650-657. [PMID: 23766052 PMCID: PMC3681456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To measure the effectiveness of implementing the chronic care model (CCM) in improving HIV clinical outcomes. DESIGN Multisite, prospective, interventional cohort study. SETTING Two urban community health centres in Vancouver and Prince George, BC. PARTICIPANTS Two hundred sixty-nine HIV-positive patients (18 years of age or older) who received primary care at either of the study sites. INTERVENTION Systematic implementation of the CCM during an 18-month period. MAIN OUTCOME MEASURES Documented pneumococcal vaccination, documented syphilis screening, documented tuberculosis screening, antiretroviral treatment (ART) status, ART status with undetectable viral load, CD4 cell count of less than 200 cells/mL, and CD4 cell count of less than 200 cells/mL while not taking ART compared during a 36-month period. RESULTS Overall, 35% of participants were women and 59% were aboriginal persons. The mean age was 45 years and most participants had a history of injection drug use that was the presumed route of HIV transmission. During the study follow-up period, 39 people died, and 11 transferred to alternate care providers. Compared with their baseline clinical status, study participants showed statistically significant (P < .001 for all) increases in pneumococcal immunization (54% vs 84%), syphilis screening (56% vs 91%), tuberculosis screening (23% vs 38%), and antiretroviral uptake (47% vs 77%), as well as increased viral load suppression rates among those receiving ART (72% vs 90%). Stable housing at baseline was associated with a 4-fold increased probability of survival. Aboriginal ethnicity was not associated with better or worse outcomes at baseline or at follow-up. CONCLUSION Application of the CCM approach to HIV care in a marginalized, largely aboriginal patient population led to improved disease screening, immunization, ART uptake, and virologic suppression rates. In addition to addressing underlying social determinants of health, a paradigm shift away from an "infectious disease" approach to a "chronic disease management" approach to HIV care for marginalized populations is strongly recommended.
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Affiliation(s)
- David Tu
- Vancouver Native Health Society, 449 Hastings St E, Vancouver, BC V6A 1P5, Canada.
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Characterizing the HIV epidemic in the prairie provinces. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013; 23:19-22. [PMID: 23449046 DOI: 10.1155/2012/408561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The numbers and demographics of HIV-positive patients in care between 2003 and 2007 in the prairie provinces were examined. METHODS Estimates of HIV-positive patients presenting to care between 2003 and 2007 were obtained from four clinic registries in Manitoba, Saskatchewan and southern Alberta. Detailed data were collected from clinical records of new patients in 2007. RESULTS By the end of December 2007, 2263 HIV-positive persons were in care in Manitoba, Saskatchewan and southern Alberta. Males and females accounted for 1674 (74.0%) and 589 of the cases, respectively. Overall, there was a 12% increase per year in new HIV cases to care between 2003 and 2007 (P=0.026), with the rate of increase for males being 60% higher than for females over this time period (P=0.002). In 2007, there were 222 new HIV cases to care (37.4% female). Heterosexual contact was the most common HIV risk, but diversity was seen across sites with frequent injection drug use and men who have sex with men risk in Saskatchewan and southern Alberta, respectively. The Aboriginal population remains heavily over-represented, with approximately 36.0% of new cases being Aboriginal. Late presentation was common across all care sites, with 35.1% of cases presenting with CD4 counts of less than 200 cells/mm(3). DISCUSSION Heterosexual risk is the most common risk reported for HIV acquisition, but injection drug use risk remains significant in Saskatchewan. Aboriginals are over-represented at all sites, and in Saskatchewan accounted for the majority of new cases seen. In contrast to national trends, numbers of new and late diagnoses are increasing in the praire provinces, and this has significant treatment implications and potential public health consequences. Further efforts need to be made to facilitate earlier testing and linkage to care. BACKGROUND The numbers and demographics of HIV-positive patients in care between 2003 and 2007 in the prairie provinces were examined. METHODS Estimates of HIV-positive patients presenting to care between 2003 and 2007 were obtained from four clinic registries in Manitoba, Saskatchewan and southern Alberta. Detailed data were collected from clinical records of new patients in 2007. RESULTS By the end of December 2007, 2263 HIV-positive persons were in care in Manitoba, Saskatchewan and southern Alberta. Males and females accounted for 1674 (74.0%) and 589 of the cases, respectively. Overall, there was a 12% increase per year in new HIV cases to care between 2003 and 2007 (P=0.026), with the rate of increase for males being 60% higher than for females over this time period (P=0.002). In 2007, there were 222 new HIV cases to care (37.4% female). Heterosexual contact was the most common HIV risk, but diversity was seen across sites with frequent injection drug use and men who have sex with men risk in Saskatchewan and southern Alberta, respectively. The Aboriginal population remains heavily over-represented, with approximately 36.0% of new cases being Aboriginal. Late presentation was common across all care sites, with 35.1% of cases presenting with CD4 counts of less than 200 cells/mm3. DISCUSSION Heterosexual risk is the most common risk reported for HIV acquisition, but injection drug use risk remains significant in Saskatchewan. Aboriginals are over-represented at all sites, and in Saskatchewan accounted for the majority of new cases seen. In contrast to national trends, numbers of new and late diagnoses are increasing in the praire provinces, and this has significant treatment implications and potential public health consequences. Further efforts need to be made to facilitate earlier testing and linkage to care.
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Martin LJ, Houston S, Yasui Y, Wild TC, Saunders LD. Poorer physical health-related quality of life among Aboriginals and injection drug users treated with highly active antiretroviral therapy. Canadian Journal of Public Health 2012. [PMID: 23618106 DOI: 10.1007/bf03405651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We compared the health-related quality of life (HRQL) of Aboriginal and non-Aboriginal HIV patients after they started highly active antiretroviral therapy (HAART) in Edmonton, Alberta and investigated whether clinical status (CD4 cell count and viral load) might explain any observed differences. METHODS In 2006-2007, eligible patients who started HAART in 1997-2005 completed the MOS-HIV to measure HRQL. Using multiple linear regression models, we compared physical (PHS) and mental (MHS) health summary scores across four groups: Aboriginals infected with HIV via injection drug use (AB/IDUs); Aboriginal non-IDUs (AB/non-IDUs); non-Aboriginal IDUs (non-AB/IDUs); and non-Aboriginal non-IDUs (non-AB/non-IDUs). To assess whether clinical status could explain any observed group differences, we fitted a model adjusting for socio-demographics (age and sex) and years since starting HAART only and then additionally adjusted for current clinical status. RESULTS Ninety-six patients were eligible (35% Aboriginal, 42% IDU). Adjusting for socio-demographics and years since starting HAART, AB/IDUs (p=0.008), AB/non-IDUs (p=0.002), and non-AB/IDUs (p=0.002) had lower PHS scores than non-AB/non-IDUs. After additionally adjusting for clinical status, these relationships remained significant for AB/non-IDUs (p=0.027) and non-AB/IDUs (p=0.048) but not for AB/IDUs (p=0.12). AB/IDUs and non-AB/IDUs tended to have worse MHS scores than non-AB/non-IDUs, but these relationships were not statistically significant and weakened after adjusting for current clinical status. CONCLUSIONS AB/IDU, AB/non-IDUs, and non-AB/IDUs had significantly poorer physical HRQL than non-AB/non-IDUs. These differences appear to be partially explained by poorer clinical status, especially for AB/IDUs, which suggests that observed inequalities in physical HRQL may be diminished by improving patients' clinical status; for example, through improved adherence to HAART.
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Affiliation(s)
- Leah J Martin
- School of Public Health, University of Alberta, Edmonton, AB.
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Jaworsky D, Monette L, Raboud J, O’Brien-Teengs D, Diong C, Blitz S, Rourke SB, Loutfy MR. Comparison of late HIV diagnosis as a marker of care for Aboriginal versus non-Aboriginal people living with HIV in Ontario. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2012; 23:e96-e102. [PMID: 24294285 PMCID: PMC3597406 DOI: 10.1155/2012/930289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies have found that Aboriginal people living with HIV/AIDS (APHAs) are more likely than non-APHAs to receive suboptimal HIV care, yet achieve similar clinical outcomes with proper care. OBJECTIVE To compare the proportions of individuals diagnosed late with HIV between APHAs and non-APHAs within the Ontario HIV Treatment Network Cohort Study (OCS). METHODS The analysis included OCS participants who completed the baseline visit by November 2009. Two definitions of the outcome of late HIV diagnosis were used: the proportion of participants with an AIDS-defining illness (ADI) before or within three months of HIV diagnosis; and the proportion of participants with a CD4(+) count <200 cells/mL at diagnosis. Logistic regression analysis was used to assess the association between Aboriginal ethnicity and late HIV diagnosis. RESULTS APHAs were more likely to be female and have lower income, education and employment. No statistically significant differences were noted in the proportions receiving a late HIV diagnosis defined by ADI (Aboriginal 5.2% versus non-Aboriginal 6.3%; P=0.40). Multivariate logistic regression analysis revealed a significant association between Aboriginal ethnicity and late HIV diagnosis defined by CD4(+) count after adjusting for age and HIV risk factor (OR 1.55; P=0.04). DISCUSSION APHAs were more likely to have a CD4(+) count <200 cells/mL at diagnosis but had similar clinical outcomes from late diagnosis when defined by ADI. However, differences may be underestimated due to recruitment limitations and selection bias. CONCLUSION Additional work is needed to address the socioeconomic and health care needs of APHAs.
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Affiliation(s)
| | | | - Janet Raboud
- University Health Network, Toronto
- Dalla Lana School of Public Health, University of Toronto, Toronto
| | - Doe O’Brien-Teengs
- Ontario Aboriginal HIV/AIDS Strategy, Toronto
- Mushkego Cree, Weenusk First Nation, Ontario
| | | | | | - Sean B Rourke
- Ontario HIV Treatment Network, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
| | - Mona R Loutfy
- Faculty of Medicine, University of Toronto, Toronto
- Women and HIV Research Program, Women’s College Research Institute, Toronto, Ontario
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Martin LJ, Houston S, Yasui Y, Wild TC, Saunders LD. Rates of initial virological suppression and subsequent virological failure after initiating highly active antiretroviral therapy: the impact of aboriginal ethnicity and injection drug use. Curr HIV Res 2011; 8:649-58. [PMID: 21187007 PMCID: PMC4428381 DOI: 10.2174/157016210794088227] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 11/22/2010] [Indexed: 11/30/2022]
Abstract
Objectives: To compare rates of initial virological suppression and subsequent virological failure by Aboriginal ethnicity after starting highly active antiretroviral therapy (HAART). Methods: We conducted a retrospective cohort study of antiretroviral-naïve HIV-patients starting HAART in January
1999-June 2005 (baseline), followed until December 31, 2005 in Alberta, Canada. We compared the odds of achieving
initial virological suppression (viral load <500 copies/mL) by Aboriginal ethnicity using logistic regression and, among
those achieving suppression, rates of virological failure (the first of two consecutive viral loads > 1000 copies/mL) by
Aboriginal ethnicity using cumulative incidence curves and Cox proportional hazards models. Sex, injection drug use as
an HIV exposure category (IDU), baseline age, CD4 cell count, viral load, calendar year, and HAART regimen were
considered as potential confounders. Results: Of 461 study patients, 37% were Aboriginal and 48% were IDUs; 71% achieved initial virological suppression
and were followed for 730.4 person-years. After adjusting for confounding variables, compared to non-Aboriginals with
other exposures, the odds of achieving initial virological suppression were lower for Aboriginal IDUs (odds ratio
(OR)=0.33, 95% CI=0.19-0.60, p=0.0002), non-Aboriginal IDUs (OR=0.30, 95% CI=0.15-0.60, p=0.0006), and
Aboriginals with other exposures (OR=0.38, 95% CI=0.21-0.67, p=0.0009). Among those achieving suppression,
Aboriginals experienced higher virological failure rates ≥1 year after suppression (hazard ratio=3.35, 95% CI=1.68-6.65,
p=0.0006). Conclusions: Future research should investigate adherence among Aboriginals and IDUs treated with HAART and
explore their treatment experiences to assess ways to improve outcomes.
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Affiliation(s)
- L J Martin
- Department of Public Health Sciences, School of Public Health, University of Alberta, Alberta, Canada.
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Monette LE, Rourke SB, Gibson K, Bekele TM, Tucker R, Greene S, Sobota M, Koornstra J, Byers S, Marks E, Bacon J, Watson JR, Hwang SW, Ahluwalia A, Dunn JR, Guenter D, Hambly K, Bhuiyan S. Inequalities in determinants of health among Aboriginal and Caucasian persons living with HIV/AIDS in Ontario: results from the Positive Spaces, Healthy Places Study. Canadian Journal of Public Health 2011. [PMID: 21714322 DOI: 10.1007/bf03404900] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Aboriginal Canadians (i.e., First Nations, Inuit and Métis) are disproportionately affected by HIV/AIDS, and experience greater social and economic marginalization and poorer housing conditions. This study sought to understand the differences in the determinants of health and housing-related characteristics between samples of Aboriginal and Caucasian adults living with HIV/AIDS in Ontario. METHODS We analyzed baseline demographic, socio-economic, health, and housing-related data from 521 individuals (79 Aboriginal and 442 Caucasian) living with HIV/AIDS and enrolled in the Positive Spaces, Healthy Places study. We compared the characteristics of Aboriginal and Caucasian participants to identify determinants of health and housing-related characteristics independently associated with Aboriginal ethnicity. RESULTS Compared to Caucausian participants living with HIV, Aboriginal participants were more likely to be younger, female or transgender women, less educated, unemployed, and homeless or unstably housed. They were also more likely to have low incomes and to have experienced housing-related discrimination. In a multivariate model, gender, income, and experiences of homelessness were independently associated with Aboriginal ethnicity. CONCLUSION Aboriginal individuals living with HIV/AIDS in our sample are coping with significantly worse social and economic conditions and are more likely to experience challenging housing situations than a comparison group of Caucasian individuals living with HIV/AIDS. To develop effective care, treatment and support strategies for Aboriginal peoples with HIV, it is critical to address and improve their socio-economic and housing conditions.
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Murray M, Hogg RS, Lima VD, May MT, Moore DM, Abgrall S, Bruyand M, D'Arminio Monforte A, Tural C, Gill MJ, Harris RJ, Reiss P, Justice A, Kirk O, Saag M, Smith CJ, Weber R, Rockstroh J, Khaykin P, Sterne JAC. The effect of injecting drug use history on disease progression and death among HIV-positive individuals initiating combination antiretroviral therapy: collaborative cohort analysis. HIV Med 2011; 13:89-97. [PMID: 21819529 DOI: 10.1111/j.1468-1293.2011.00940.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined whether determinants of disease progression and causes of death differ between injecting drug users (IDUs) and non-IDUs who initiate combination antiretroviral therapy (cART). METHODS The ART Cohort Collaboration combines data from participating cohort studies on cART-naïve adults from cART initiation. We used Cox models to estimate hazard ratios for death and AIDS among IDUs and non-IDUs. The cumulative incidence of specific causes of death was calculated and compared using methods that allow for competing risks. RESULTS Data on 6269 IDUs and 37 774 non-IDUs were analysed. Compared with non-IDUs, a lower proportion of IDUs initiated cART with a CD4 cell count <200 cells/μL or had a prior diagnosis of AIDS. Mortality rates were higher in IDUs than in non-IDUs (2.08 vs. 1.04 per 100 person-years, respectively; P<0.001). Lower baseline CD4 cell count, higher baseline HIV viral load, clinical AIDS at baseline, and later year of cART initiation were associated with disease progression in both groups. However, the inverse association of baseline CD4 cell count with AIDS and death appeared stronger in non-IDUs than in IDUs. The risk of death from each specific cause was higher in IDUs than non-IDUs, with particularly marked increases in risk for liver-related deaths, and those from violence and non-AIDS infection. CONCLUSION While liver-related deaths and deaths from direct effects of substance abuse appear to explain much of the excess mortality in IDUs, they are at increased risk for many other causes of death, which may relate to suboptimal management of HIV disease in these individuals.
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Affiliation(s)
- M Murray
- Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
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All-cause and HIV-related mortality rates among HIV-infected patients after initiating highly active antiretroviral therapy: the impact of Aboriginal ethnicity and injection drug use. Canadian Journal of Public Health 2011. [PMID: 21608378 DOI: 10.1007/bf03404154] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Aboriginals are over-represented in Canada's HIV epidemic and are commonly infected with HIV via injection drug use (IDU); however, little is known about the impact of Aboriginal ethnicity on mortality after starting highly active antiretroviral therapy (HAART). Therefore, we compared mortality rates between Aboriginal and non-Aboriginal HIV patients and between IDU and non-IDU HIV patients after they initiated HAART. METHODS We conducted a retrospective cohort study of antiretroviral-naïve patients starting HAART January 1999-June 2005 (baseline), followed until December 2005. We constructed two Cox proportional hazards models, one to estimate all-cause and one to estimate HIV-related mortality hazard ratios (HRs), considering sex, and baseline age, CD4 cell count, HIV RNA level, calendar year, and HAART regimen as potential confounders. RESULTS The 548 study patients were followed for 1,889.8 person-years; 194 (35%) were Aboriginal, 255 (46%) were IDUs. We observed 55 deaths; 47% were HIV-related. In multivariable models, Aboriginals experienced higher all-cause (HR = 1.85, 95% CI = 1.05-3.26, p = 0.034) and HIV-related (HR = 3.47, 95% CI = 1.36-8.83, p = 0.009) mortality rates compared to non-Aboriginals; and, compared to patients with other exposures, IDUs experienced higher all-cause (HR = 2.45, 95% CI = 1.31-4.57, p = 0.005) but similar HIV-related (p = 0.27) mortality rates. CONCLUSIONS Compared to non-Aboriginals, Aboriginal HIV patients suffer higher all-cause and HIV-related mortality rates after starting HAART. The strongest and most significant predictor of higher all-cause mortality was IDU. Future research should examine reasons for the observed poorer survival of Aboriginal and IDU HIV patients after initiating HAART to develop interventions to improve the prognosis for these vulnerable populations.
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Monette LE, Rourke SB, Gibson K, Bekele TM, Tucker R, Greene S, Sobota M, Koornstra J, Byers S, Marks E, Bacon J, Watson JR, Hwang SW, Ahluwalia A, Dunn JR, Guenter D, Hambly K, Bhuiyan S. Inequalities in determinants of health among Aboriginal and Caucasian persons living with HIV/AIDS in Ontario: results from the Positive Spaces, Healthy Places Study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2011; 102:215-9. [PMID: 21714322 PMCID: PMC6974182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 12/04/2010] [Indexed: 03/29/2024]
Abstract
OBJECTIVES Aboriginal Canadians (i.e., First Nations, Inuit and Métis) are disproportionately affected by HIV/AIDS, and experience greater social and economic marginalization and poorer housing conditions. This study sought to understand the differences in the determinants of health and housing-related characteristics between samples of Aboriginal and Caucasian adults living with HIV/AIDS in Ontario. METHODS We analyzed baseline demographic, socio-economic, health, and housing-related data from 521 individuals (79 Aboriginal and 442 Caucasian) living with HIV/AIDS and enrolled in the Positive Spaces, Healthy Places study. We compared the characteristics of Aboriginal and Caucasian participants to identify determinants of health and housing-related characteristics independently associated with Aboriginal ethnicity. RESULTS Compared to Caucausian participants living with HIV, Aboriginal participants were more likely to be younger, female or transgender women, less educated, unemployed, and homeless or unstably housed. They were also more likely to have low incomes and to have experienced housing-related discrimination. In a multivariate model, gender, income, and experiences of homelessness were independently associated with Aboriginal ethnicity. CONCLUSION Aboriginal individuals living with HIV/AIDS in our sample are coping with significantly worse social and economic conditions and are more likely to experience challenging housing situations than a comparison group of Caucasian individuals living with HIV/AIDS. To develop effective care, treatment and support strategies for Aboriginal peoples with HIV, it is critical to address and improve their socio-economic and housing conditions.
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Affiliation(s)
| | - Sean B. Rourke
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
- Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
| | - Katherine Gibson
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Tsegaye M. Bekele
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Ruthann Tucker
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Saara Greene
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
- Faculty of Social Sciences, McMaster University, Toronto, ON Canada
- Fife House, Toronto, ON Canada
| | - Michael Sobota
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
- AIDS Thunder Bay, Thunder Bay, ON Canada
| | - Jay Koornstra
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
- Bruce House, Ottawa, ON Canada
| | | | - Elisabeth Marks
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
| | - James R. Watson
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Stephen W. Hwang
- Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | | | - James R. Dunn
- Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Health, Aging & Society, McMaster University, Hamilton, ON Canada
| | - Dale Guenter
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | | | - Shafi Bhuiyan
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
| | - Positive Spaces, Healthy Places Team
- Ontario Aboriginal HIV/AIDS Strategy, Toronto, ON Canada
- Ontario HIV Treatment Network, The Ontario HIV Treatment Network, 600–1300 Yonge St., M4T 1X3 Toronto, ON Canada
- Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- The CIHR Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health), Toronto, ON Canada
- Faculty of Social Sciences, McMaster University, Toronto, ON Canada
- Fife House, Toronto, ON Canada
- AIDS Thunder Bay, Thunder Bay, ON Canada
- Bruce House, Ottawa, ON Canada
- AIDS Niagara, St. Catharines, ON Canada
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Department of Health, Aging & Society, McMaster University, Hamilton, ON Canada
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
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Martin LJ, Houston S, Yasui Y, Wild TC, Saunders LD. All-cause and HIV-related mortality rates among HIV-infected patients after initiating highly active antiretroviral therapy: the impact of Aboriginal ethnicity and injection drug use. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2011; 102:90-6. [PMID: 21608378 PMCID: PMC6974008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 10/12/2010] [Accepted: 10/24/2010] [Indexed: 07/26/2024]
Abstract
BACKGROUND Aboriginals are over-represented in Canada's HIV epidemic and are commonly infected with HIV via injection drug use (IDU); however, little is known about the impact of Aboriginal ethnicity on mortality after starting highly active antiretroviral therapy (HAART). Therefore, we compared mortality rates between Aboriginal and non-Aboriginal HIV patients and between IDU and non-IDU HIV patients after they initiated HAART. METHODS We conducted a retrospective cohort study of antiretroviral-naïve patients starting HAART January 1999-June 2005 (baseline), followed until December 2005. We constructed two Cox proportional hazards models, one to estimate all-cause and one to estimate HIV-related mortality hazard ratios (HRs), considering sex, and baseline age, CD4 cell count, HIV RNA level, calendar year, and HAART regimen as potential confounders. RESULTS The 548 study patients were followed for 1,889.8 person-years; 194 (35%) were Aboriginal, 255 (46%) were IDUs. We observed 55 deaths; 47% were HIV-related. In multivariable models, Aboriginals experienced higher all-cause (HR = 1.85, 95% CI = 1.05-3.26, p = 0.034) and HIV-related (HR = 3.47, 95% CI = 1.36-8.83, p = 0.009) mortality rates compared to non-Aboriginals; and, compared to patients with other exposures, IDUs experienced higher all-cause (HR = 2.45, 95% CI = 1.31-4.57, p = 0.005) but similar HIV-related (p = 0.27) mortality rates. CONCLUSIONS Compared to non-Aboriginals, Aboriginal HIV patients suffer higher all-cause and HIV-related mortality rates after starting HAART. The strongest and most significant predictor of higher all-cause mortality was IDU. Future research should examine reasons for the observed poorer survival of Aboriginal and IDU HIV patients after initiating HAART to develop interventions to improve the prognosis for these vulnerable populations.
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Affiliation(s)
- Leah J Martin
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB.
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Moore DM, Zhang W, Yip B, Genebat M, Lima VD, Montaner JSG, Hogg RS. Non-medically supervised treatment interruptions among participants in a universally accessible antiretroviral therapy programme. HIV Med 2009; 11:299-307. [PMID: 20002777 DOI: 10.1111/j.1468-1293.2009.00779.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined clinical outcomes, patient characteristics and trends over time of non-medically supervised treatment interruptions (TIs) from a free-of-charge antiretroviral therapy (ART) programme in British Columbia (BC), Canada. METHODS Data from ART-naïve individuals > or =18 years old who initiated triple combination highly active antiretroviral therapy (HAART) between January 2000 and June 2006 were analysed. Participants having > or =3 month gap in HAART coverage were defined as having a TI. Cox proportional hazards modelling was used to examine factors associated with TIs and to examine factors associated with resumption of treatment. RESULTS A total of 1707 participants were study eligible and 643 (37.7%) experienced TIs. TIs within 1 year of ART initiation decreased from 29% of individuals in 2000 to 19% in 2006 (P<0.001). TIs were independently associated with a history of injection drug use (IDU) (P=0.02), higher baseline CD4 cell counts (P<0.001), hepatitis C co-infection (P<0.001) and the use of nelfinavir (NFV) (P=0.04) or zidovudine (ZDV)/lamivudine (3TC) (P=0.009) in the primary HAART regimen. Male gender (P<0.001), older age (P<0.001), AIDS at baseline (P=0.008) and having a physician who had prescribed HAART to fewer patients (P=0.03) were protective against TIs. Four hundred and eighty-eight (71.9%) participants eventually restarted ART with male patients and those who developed an AIDS-defining illness prior to their TI more likely to restart therapy. Higher CD4 cell counts at the time of TI and unknown hepatitis C status were associated with a reduced likelihood of restarting ART. CONCLUSION Treatment interruptions were associated with younger, less ill, female and IDU participants. Most participants with interruptions eventually restarted therapy. Interruptions occurred less frequently in recent years.
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Affiliation(s)
- D M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
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The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr 2009; 52:342-9. [PMID: 19675463 DOI: 10.1097/qai.0b013e3181b627c2] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Food insecurity is increasingly recognized as a barrier to optimal treatment outcomes, but there is little data on this issue. We assessed associations between food insecurity and mortality among HIV-infected antiretroviral therapy-treated individuals in Vancouver, British Columbia, and whether body max index (BMI) modified associations. METHODS Individuals were recruited from the British Columbia HIV/AIDS drug treatment program in 1998 and 1999 and were followed until June 2007 for outcomes. Food insecurity was measured with the Radimer/Cornell questionnaire. Cox proportional hazard models were used to determine associations between food insecurity, BMI, and nonaccidental deaths when controlling for confounders. RESULTS Among 1119 participants, 536 (48%) were categorized as food insecure and 160 (14%) were categorized as underweight (BMI < 18.5). After a median follow-up time of 8.2 years, 153 individuals (14%) had died from nonaccidental deaths. After controlling for adherence, CD4 counts, and socioeconomic variables, people who were food insecure and underweight were nearly 2 times more likely to die (adjusted hazard ratio = 1.94, 95% confidence interval = 1.10 to 3.40) compared with people who were not food insecure or underweight. There was also a trend toward increased risk of mortality among people who were food insecure and not underweight (adjusted hazard ratio = 1.40, 95% confidence interval = 0.91 to 2.05). In contrast, people who were underweight but food secure were not more likely to die. CONCLUSIONS Food insecurity is a risk factor for mortality among antiretroviral therapy-treated individuals in British Columbia, particularly among individuals who are underweight. Innovative approaches to address food insecurity should be incorporated into HIV treatment programs.
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Mill JE, Jackson RC, Worthington CA, Archibald CP, Wong T, Myers T, Prentice T, Sommerfeldt S. HIV testing and care in Canadian Aboriginal youth: a community based mixed methods study. BMC Infect Dis 2008; 8:132. [PMID: 18840292 PMCID: PMC2573888 DOI: 10.1186/1471-2334-8-132] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 10/07/2008] [Indexed: 12/03/2022] Open
Abstract
Background HIV infection is a serious concern in the Canadian Aboriginal population, particularly among youth; however, there is limited attention to this issue in research literature. The purpose of this national study was to explore HIV testing and care decisions of Canadian Aboriginal youth. Methods A community-based mixed-method design incorporating the Aboriginal research principles of Ownership, Control, Access and Possession (OCAP) was used. Data were collected through surveys (n = 413) and qualitative interviews (n = 28). Eleven community-based organizations including urban Aboriginal AIDS service organizations and health and friendship centres in seven provinces and one territory assisted with the recruitment of youth (15 to 30 years). Results Average age of survey participants was 21.5 years (median = 21.0 years) and qualitative interview participants was 24.4 years (median = 24.0). Fifty-one percent of the survey respondents (210 of 413 youth) and 25 of 28 interview participants had been tested for HIV. The most common reason to seek testing was having sex without a condom (43.6%) or pregnancy (35.4%) while common reasons for not testing were the perception of being low HIV risk (45.3%) or not having had sex with an infected person (34.5%). Among interviewees, a contributing reason for not testing was feeling invulnerable. Most surveyed youth tested in the community in which they lived (86.5%) and 34.1% visited a physician for the test. The majority of surveyed youth (60.0%) had tested once or twice in the previous 2 years, however, about one-quarter had tested more than twice. Among the 26 surveyed youth who reported that they were HIV-positive, 6 (23.1%) had AIDS at the time of diagnosis. Delays in care-seeking after diagnosis varied from a few months to seven years from time of test. Conclusion It is encouraging that many youth who had tested for HIV did so based on a realistic self-assessment of HIV risk behaviours; however, for others, a feeling of invulnerability was a barrier to testing. For those who tested positive, there was often a delay in accessing health services.
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Affiliation(s)
- Judy E Mill
- Faculty of Nursing, University of Alberta, 7-50 University Terrace, Edmonton, Alberta, Canada.
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