Admassu Zerihun, Logie Carmen H, Vahedi Luissa, Underhill Angela, Kennedy Logan, Webster Kath, Gagnier Brenda, Kaida Angela, de Pokomandy Alexandra, Loutfy Mona R
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
Research and Innovation Institute, Women's College Hospital, Toronto, Ontario, Canada.
HIV Med. 2025 Jun;26(6):962-969. doi: 10.1111/hiv.70031. Epub 2025 Apr 14.
BACKGROUND: Social determinants of health (SDoH) can significantly impact overall well-being. While existing research has explored SDoH as predictors of well-being among women living with HIV, longitudinal studies examining these relationships over time remain limited. We examined SDoH typologies among women living with HIV in Canada and longitudinal associations with well-being. METHODS: Using longitudinal survey data collected at three time points from women living with HIV in Canada (2013-2018), we conducted latent class analysis (LCA) to identify subgroups of SDoH indicators, including income, experiences of violence, food security, substance use, housing stability, HIV-related stigma and social support at baseline (Time-1). Multivariable linear and logistic regression examined associations between SDoH classes and well-being (depression, discrimination [gender, racial] and HIV clinical outcomes [viral load, adherence, HIV care barriers]) at Time-3. RESULTS: We identified three distinct SDoH classes among participants (n = 1422, mean age = 42.8): high (n = 435; 30.6%), medium (n = 377; 26.5%) and low SDoH adversity (n = 610; 42.9%). In multivariate regression analyses, the high SDoH adversity class had lower odds of achieving an undetectable viral load (adjusted Odds Ratio [aOR] = 0.46; 95% CI: 0.21, 1.01; p = 0.050) and higher probability of facing barriers to accessing care (aβ = 0.32; 95% CI: 0.19, 0.45; p < 0.001), depression (aOR = 2.52; 95% CI: 1.71, 3.71; p < 0.001), racial discrimination (aβ = 3.42; 95% CI: 1.72, 5.12; p < 0.001) and gender discrimination (aβ = 3.14; 95% CI: 1.42, 4.87; p < 0.001), compared with the low SDoH adversity class at 5-year follow-up. CONCLUSIONS: SDoH adversities were associated with poor wellbeing among women living with HIV in Canada. Integrated, comprehensive person-centred care approaches that address SDoH are needed to improve health and wellbeing.
背景：健康的社会决定因素（SDoH）会对整体幸福感产生重大影响。虽然现有研究已将SDoH作为感染艾滋病毒女性幸福感的预测因素进行了探索，但随着时间推移考察这些关系的纵向研究仍然有限。我们研究了加拿大感染艾滋病毒女性中的SDoH类型及其与幸福感的纵向关联。 方法：利用在三个时间点从加拿大感染艾滋病毒女性（2013 - 2018年）收集的纵向调查数据，我们进行了潜在类别分析（LCA），以识别SDoH指标的亚组，包括基线时（时间1）的收入、暴力经历、食品安全、物质使用、住房稳定性、与艾滋病毒相关的耻辱感和社会支持。多变量线性和逻辑回归分析了时间3时SDoH类别与幸福感（抑郁、歧视[性别、种族]和艾滋病毒临床结果[病毒载量、依从性、艾滋病毒护理障碍]）之间的关联。 结果：我们在参与者（n = 1422，平均年龄 = 42.8岁）中识别出三种不同的SDoH类别：高（n = 435；30.6%）、中（n = 377；26.5%）和低SDoH逆境（n = 610；42.9%）。在多变量回归分析中，与5年随访时的低SDoH逆境类别相比，高SDoH逆境类别实现不可检测病毒载量的几率较低（调整后的优势比[aOR] = 0.46；95%置信区间：0.21，1.01；p = 0.050）且面临护理障碍的概率较高（aβ = 0.32；95%置信区间：0.19，0.45；p < 0.001）、抑郁（aOR = 2.52；95%置信区间：1.71，3.71；p < 0.001）、种族歧视（aβ = 3.42；95%置信区间：1.72，5.12；p < 0.001）和性别歧视（aβ = 3.14；95%置信区间：1.42，4.87；p < 0.001）。 结论：在加拿大，SDoH逆境与感染艾滋病毒女性的幸福感较差有关。需要采用综合、全面的以患者为中心的护理方法来解决SDoH问题，以改善健康和幸福感。
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