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Nuño N, Martínez A, Martínez S, Cobos M, Hernández JS, Polo R. Sex differences in health-related quality of life and poverty risk among older people living with HIV in Spain: A cross-sectional study. PLoS One 2024; 19:e0301335. [PMID: 38713682 DOI: 10.1371/journal.pone.0301335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/14/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Current antiretroviral therapies have increased the life expectancy of people living with HIV (PLHIV). There is, however, limited evidence regarding the health-related quality of life (HRQoL) and living conditions of older people living with HIV (OPLHIV) in Spain. METHODS We implemented a self-administered online questionnaire to identify sex differences in HRQoL and poverty risk among Spanish OPLHIV (PLHIV ≥50 years). Participants were contacted through non-governmental organisations. We used the standardised WHOQoL-HIV BREF questionnaire and the Europe 2020 guidelines to estimate HRQoL and poverty risk respectively. The statistical analysis included multivariable generalised linear models with potential confounding variables and robust estimates. RESULTS The study included 247 OPLHIV (192 men and 55 women). On the WHOQoL-HIV BREF questionnaire, men scored higher on 84% of items and in all six domains. Women had significantly lower HRQoL in five domains: physical health (β: -1.5; 95% CI: -2.5, -0.5; p: 0.002), psychological health (β: -1.0; 95% CI: -1.9, -0.1; p: 0.036), level of independence (β: -1.1; 95% CI: -1.9, -0.2; p: 0.019), environmental health (β: -1.1; 95% CI: -1.8, -0.3; p: 0.008), and spirituality/personal beliefs (β: -1.4; 95% CI: -2.5, -0.3; p: 0.012). No statistical differences were found in the domain of social relations. Poverty risk was considerable for both men (30%) and women (53%), but women were significantly more likely to experience it (OR: 2.9; 95% CI: 1.3, 6.5; p: 0.009). CONCLUSION The aging of PLHIV is a public health concern. Our findings indicate that HRQoL and poverty risk among Spanish OPLHIV differ significantly by sex. Spain should, therefore, implement specific policies and interventions to address OPLHIV needs. The strategies must place a high priority on the reduction of sex inequalities in HRQoL and the enhancement of the structural conditions in which OPLHIV live.
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Affiliation(s)
- Néstor Nuño
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
| | - Alberto Martínez
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
| | - Susana Martínez
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
| | - Marta Cobos
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
| | | | - Rosa Polo
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
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Perri M, Hapsari AP, Craig-Neil A, Ho J, Cattaneo J, Gaspar M, Hunter C, Rueda S, Burchell AN, Pinto AD. An evaluation of an employment assistance program focused on people living with HIV in Toronto, Canada. AIDS Care 2024; 36:500-507. [PMID: 37756653 DOI: 10.1080/09540121.2023.2253505] [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: 03/28/2022] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Unemployment is more common among people living with HIV (PLWH) compared to the general population. PLWH who are employed have better physical and mental health outcomes compared to unemployed PLWH. The main objective of this mixed-methods study was to conduct a program evaluation of Employment Action (EACT), a community-based program that assists PLWH in Toronto, Ontario, Canada to maintain meaningful employment. We extracted quantitative data from two HIV services databases used by EACT, and collected qualitative data from 12 individuals who had been placed into paid employment through EACT. From 131 clients included in the analysis, 38.1% (n = 50) maintained their job for at least 6 weeks within the first year of enrollment in the EACT program. Gender, ethnicity, age, and first language did not predict employment maintenance. Our interviews highlighted the barriers and facilitators to effective service delivery. Key recommendations include implementing skills training, embedding PLWH as EACT staff, and following up with clients once they gain employment. Investment in social programs such as EACT are essential for strengthening their data collection capacity, active outreach to service users, and sufficient planning for the evaluation phase prior to program implementation.
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Affiliation(s)
- Melissa Perri
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ayu Pinky Hapsari
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Julia Ho
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | | | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Charlotte Hunter
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Aung HNY, Riewpaiboon A, Sunantiwat M, Thavorncharoensap M, Hone S. Economic burden on people living with HIV who attend self-help groups in Yangon, Myanmar. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1530-1540. [PMID: 34216061 DOI: 10.1111/hsc.13483] [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: 02/23/2020] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
This study aims to determine economic burden or cost of human immunodeficiency virus (HIV) and its consequences from patient perspective and to examine factors influencing the cost. This is a prevalence-based cost-of-illness (COI) study. A cross-sectional survey was carried out in Yangon, Myanmar during March and April 2018. Face-to-face structured interview was conducted among 264 people living with HIV (PLHIV) who were members of the selected four self-help groups (SHGs) that provided HIV peer support. Micro-costing approach was adopted for the cost calculation. Direct medical cost, direct non-medical cost and indirect cost were considered. Cost of HIV per patient in the year 2017 was estimated at 228.2 international dollar (Int$). Direct medical cost was only small portion of the total cost (5.6%). Indirect cost or cost of time loss was the largest contributor among the cost components, accounted for 61.2% of the total cost. First year of the antiretroviral therapy (ART) initiation and second line drug regimen have positive effect on the costs. HIV resulted in substantial economic burden for the patients. Effective interventions aim at reducing the economic burden on patients by providing compensation on transportation cost and providing job opportunity are essential. Further researchers examining cost from provider and societal perspectives are warranted to provide complete picture of the economic burden of HIV in Myanmar.
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Affiliation(s)
- Hsu Nwe Yee Aung
- Master of Science Program in Social, Economic and Administrative Pharmacy (SEAP), Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Defect Malaria Project, American Refugee Committee, Bokpyin, Myanmar
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montaya Sunantiwat
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - San Hone
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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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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Barry M, Ghonem L, Albeeshi N, Alrabiah M, Alsharidi A, Al-Omar HA. Resource Utilization and Caring Cost of People Living with Human Immunodeficiency Virus (PLHIV) in Saudi Arabia: A Tertiary Care University Hospital Experience. Healthcare (Basel) 2022; 10:118. [PMID: 35052282 PMCID: PMC8776132 DOI: 10.3390/healthcare10010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
The human immunodeficiency virus (HIV) is associated with a significant burden of disease, including medical and non-medical costs. Therefore, it is considered to be a priority for all health authorities. The aim of this study is to determine healthcare and treatment costs of caring for PLHIV at one of the tertiary care university hospitals in Riyadh, Saudi Arabia. This was a micro-costing, retrospective, observational study from a tertiary care university hospital and included all confirmed HIV-infected patients who visited infectious disease clinics in the period from 1 January 2015 to 31 December 2018. A total of 42 PLHIV were included in this study. The mean age of the study participants was 38.76 ± 11.47 years with a mean disease duration of 5.27 ± 4.81 years. The majority of patients were male (85.7%) and Saudi (88.1%). More than half of included patients (59.5%) had a CD4 count of more than 500. During the study period, 26 patients (61.9%) were initiated on a single-tablet regimen. Overall, the main cost-driver was antiretroviral medications, which cumulatively represented more than 64% of the total cost. Patients who developed opportunistic infections had a statistically significant (p = 0.033) higher financial impact, both as a total and on a patient level, than those presented without opportunistic infections. On a patient level, the mean and median costs were higher and statistically significant for those with co-morbidities than those without co-morbidities (p = 0.002). The majority of the economic burden of PLHIV is attributable to antiretroviral therapy use. The healthcare costs of PLHIV can vary greatly, depending on the presenting illness, clinical stage, developed opportunistic infection, co-morbidity, and pharmacological therapy.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 11451, Saudi Arabia; (M.B.); (A.A.)
| | - Leen Ghonem
- Department of Pharmacy, King Saud University Medical City, Riyadh 12372, Saudi Arabia;
| | - Nourah Albeeshi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
| | - Maha Alrabiah
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 12372, Saudi Arabia;
| | - Aynaa Alsharidi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 11451, Saudi Arabia; (M.B.); (A.A.)
| | - Hussain Abdulrahman Al-Omar
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Health Technology Assessment Unit, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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6
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Folayan MO, Ibigbami O, El Tantawi M, Brown B, Aly NM, Ezechi O, Abeldaño GF, Ara E, Ayanore MA, Ellakany P, Gaffar B, Al-Khanati NM, Idigbe I, Ishabiyi AO, Jafer M, Khan ATA, Khalid Z, Lawal FB, Lusher J, Nzimande NP, Osamika BE, Quadri MFA, Roque M, Al-Tammemi AB, Yousaf MA, Virtanen JI, Zuñiga RAA, Okeibunor JC, Nguyen AL. Factors Associated with Financial Security, Food Security and Quality of Daily Lives of Residents in Nigeria during the First Wave of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7925. [PMID: 34360217 PMCID: PMC8345729 DOI: 10.3390/ijerph18157925] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 12/19/2022]
Abstract
An online survey was conducted to identify factors associated with financial insecurity, food insecurity and poor quality of daily lives of adults in Nigeria during the first wave of the COVID-19 pandemic. The associations between the outcome (experience of financial loss, changes in food intake and impact of the pandemic on daily lives) and the explanatory (age, sex, education level, anxiety, depression, HIV status) variables were determined using logistic regression analysis. Of the 4439 respondents, 2487 (56.0%) were financially insecure, 907 (20.4%) decreased food intake and 4029 (90.8%) had their daily life negatively impacted. Males (AOR:0.84), people who felt depressed (AOR:0.62) and people living with HIV -PLHIV- (AOR:0.70) had significantly lower odds of financial insecurity. Older respondents (AOR:1.01) had significantly higher odds of financial insecurity. Those depressed (AOR:0.62) and PLHIV (AOR:0.55) had significantly lower odds of reporting decreased food intake. Respondents who felt anxious (AOR:0.07), depressed (AOR: 0.48) and who were PLHIV (AOR:0.68) had significantly lower odds of reporting a negative impact of the pandemic on their daily lives. We concluded the study findings may reflect a complex relationship between financial insecurity, food insecurity, poor quality of life, mental health, and socioeconomic status of adults living in Nigeria during the COVID-19 pandemic.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
| | - Olanrewaju Ibigbami
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
| | - Maha El Tantawi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Brandon Brown
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, Riverside, CA 92501, USA
| | - Nourhan M. Aly
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Oliver Ezechi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos 101212, Nigeria
| | - Giuliana Florencia Abeldaño
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Institute for Research on Public Health, School of Medicine, University of Sierra Sur, Oaxaca 70805, Mexico
| | - Eshrat Ara
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Government College for Women, Moulana Azad Road, Srinagar Kashmir, J&K 190001, India
| | - Martin Amogre Ayanore
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Health Policy Planning and Management, University of Health and Allied Sciences, PMB 31 Ho, Ghana
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Preventive Dentistry, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Nuraldeen Maher Al-Khanati
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus 36822, Syria
| | - Ifeoma Idigbe
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos 101212, Nigeria
| | - Anthonia Omotola Ishabiyi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Mohammed Jafer
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Preventive Dental Sciences, Faculty of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Abeedha Tu-Allah Khan
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- School of Biological Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore 54590, Pakistan
| | - Zumama Khalid
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- School of Biological Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore 54590, Pakistan
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Periodontology and Community Dentistry, University of Ibadan, Ibadan 200212, Nigeria
| | - Joanne Lusher
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- School of Health and Life Sciences, University of the West of Scotland, London E142BE, UK
| | - Ntombifuthi P. Nzimande
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Economic and Human Geography, Faculty of Geosciences, University of Szeged, H-6722 Szeged, Hungary
| | - Bamidele Emmanuel Osamika
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Psychology, Faculty of Environment, Management and Social Sciences, Lead City University, Ibadan 200255, Nigeria
| | - Mir Faeq Ali Quadri
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Division of Dental Public Health, Department of Preventive Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Mark Roque
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Maternity & Childhood Nursing, College of Nursing, Taibah University, Madinah 42223, Saudi Arabia
| | - Ala’a B. Al-Tammemi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Family and Occupational Medicine, Faculty of Medicine, Doctoral School of Health Sciences, University of Debrecen, H-4032 Debrecen, Hungary
| | - Muhammad Abrar Yousaf
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Institute of Zoology, University of the Punjab, Quaid-i-Azam Campus, Lahore 54590, Pakistan
| | - Jorma I. Virtanen
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Faculty of Medicine, University of Turku, FI-20014 Turku, Finland
| | - Roberto Ariel Abeldaño Zuñiga
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Post Graduate School, University of Sierra Sur, Oaxaca 70800, Mexico
| | - Joseph Chukwudi Okeibunor
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Research Development and Innovations, Assistant Regional Director Cluster, WHO Regional Office for Africa, Brazzaville BP 06, Congo
| | - Annie Lu Nguyen
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
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Perri M, Craig-Neil A, Gaspar M, Hunter C, Kendall C, Alexander O, Pinto AD. A qualitative study of barriers to employment experienced by people living with HIV in Toronto and Ottawa. Int J Equity Health 2021; 20:36. [PMID: 33446215 PMCID: PMC7807879 DOI: 10.1186/s12939-020-01356-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Effective treatment has extended the life expectancy and reduced disability in people living with HIV (PLWH). However, previous research has found 45-65% of working-age PLWH were unemployed compared to 5-10% in the general public of North America and Europe. We examined the barriers to gaining employment among PLWH. METHODS Thirty-five in-depth interviews were conducted in person or over the phone with PLWH living in Toronto or Ottawa. This included PLWH who were unemployed but actively seeking employment, as well as PLWH who had successfully gained employment through an agency that specifically supported PLWH funded by the AIDS Committee of Toronto. Interviews were conducted between February 2019 and March 2020. All interviews were audio-recorded, transcribed and analyzed using thematic analysis. RESULTS The majority of participants were between the ages of 40-55 and identified as male. Participants shared many common barriers when describing their attempts to attain or maintain employment. Although varying in employment status at the time of the study, consistent barriers included experiencing HIV stigma in workplaces, challenges overcoming mental health illnesses, and difficulties in navigating social assistance and unemployment insurance programs when pursuing a return to work. CONCLUSIONS PLWH face significant barriers when attempting to engage with employment opportunities. Health providers and organizations can do more to support campaigns to end HIV stigma, to support individuals in pursuing employment, and to advocate for policy change that supports reentry into the workforce for PLHA.
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Affiliation(s)
- Melissa Perri
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada
| | - Charlotte Hunter
- Casey House, 119 Isabella St, Toronto, Ontario, M4Y 1P2, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Claire Kendall
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent Suite 201, Ottawa, Ontario, K1G 5Z3, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 85 Primrose Ave, Ottawa, Ontario, K1R 6M1, Canada
- Institut du Savoir Montfort, Montfort Hospital, 713 Montreal Rd, Ottawa, Ontario, K1K OT2, Canada
- Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, Ontario, K1H 8L6, Canada
- Li Ka Shing Knowledge Institute, 209 Victoria St, Toronto, Ontario, M5B 1T8, Canada
| | - Ower Alexander
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- University of Toronto Practice-Based Research Network, 500 University Avenue, Toronto, Ontario, K1H 8L6, Canada.
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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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