Alexis Palmer

Drug Treatment ProgramBC Centre for Excellence in HIV/AIDS

Home is where the HAART is: An examination of the factors affecting neighbourhood perception for people living with HIV/AIDS

Background

Neighbourhood Perceptions

Social factors

HIV health

Health status & overall well-being

• Problems

• Cohesion

• Standard of Living

• Food security

• Stable housing

• Gender

• Employment

• Education

• Drug use

• QoLife Components

• CD4

• Viral load suppression

• Depression

• On HAART

Background

Neighbourhood Perceptions

Problems

Cohesion

Standard of Living

Background

Neighbourhood Perceptions

Problems

Cohesion

Standard of Living

“In your neighbourhood, how much of a problem are the following?”

• Litter, rubbish, & vandalism

• Assaults, muggings, & burglaries

• Reputation of the neighbourhood

• Lack of recreational facilities

Background

Neighbourhood Perceptions

Problems

Cohesion

Standard of Living

“Thinking about your neighbors and the other people that live in your neighbourhood, tell us how you feel about the following statements”

• I believe my neighbors would help in an emergency

• I feel like I belong to this neighbourhood

• I agree with people in my neighbourhood about what is important in life

• Living in this neighbourhood gives me a sense of community

Background

Neighbourhood Perceptions

Problems

Cohesion

Standard of Living

“Comparing your standard of living to your neighbors, would you say you are”

• much better off

• a little better off

• about the same

• a little worse off

• much worse off

Objectives

1. To identify the factors associated with neighbourhood perceptions

2. To assess the role of food security and stable housing on neighbourhood perceptions

Methods Longitudinal Investigations into Supportive and Ancillary health services

(LISA) cohort is a prospective study of HIV+ persons on HAART

Participants recruited from the Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS

Interview administered survey that collects information

Univariable analyses examined the associations between PROBLEMS and COHESION and a series of explanatory variables

Univariable analyses used to test association of CD4 count and viral load with food security and stable housing

Wilcoxon Rank-sum test used for continuous variables and Fisher’s Exact test used for categorical variables

Multivariable analyses used to explore impact of food security and stable housing on perceptions of neighbourhood PROBLEMS and COHESION

Results

LISA Cohort (n=510)

Food Insecure 71%

Unstable Housing 35%

Male 76%

Currently Employed 23%

High school Education or Greater 56%

Illicit Drug Use Never Drugs Yes, Not Current Current

14.5%37.3%48.2%

Age (median) 45.7 (40.2-51.8)

Results (2) Social factors

Mean scores Problems Cohesion

Food secure 23 vs 41 64 vs 54

Stable housing 29 vs 49 60 vs 51

Male 34 vs 43 58 vs 53

Employed 26 vs 39 61 vs 56

>High school education 34 vs 39 60 vs 54

Current drug user 47 vs 26 54 vs 60

*Bold is statistically significant p < 0.05

Results (3) Social factors

PercentagesStandard of Living

Better Same Worse

Food secureYN

39%26%

48%47%

13%27%

Stable housingYN

28%34%

47%47%

25%19%

MaleYN

30%32%

48%42%

22%26%

EmployedYN

31%30%

52%45%

17%25%

>High school educationYN

29%31%

50%43%

21%26%

Current drug userYN

32%28%

47%47%

21%25%

*Bold is statistically significant p < 0.05

Results (4) HIV health

Mean scores Problems Cohesion

CD4 > 200 33 vs 43 58 vs 56

Suppressed viral load 33 vs 41 58 vs 55

Depression 42 vs 28 54 vs 61

On HAART 35 vs 43 57 vs 56

*Bold is statistically significant p < 0.05

Results (5) HIV health

PercentagesStandard of Living

Better Same Worse

CD4 > 20030%29%

48%43%

22%28%

Suppressed viral load31%28%

48%48%

21%24%

Depression27%34%

45%50%

28%16%

On HAART31%25%

47%45%

22%30%

*Bold is statistically significant p < 0.05

Results (6) Multivariable confounder model

Coefficient Problems CohesionFood secure -7.3 6.6

Stable housing -13.1 5.6

Male -6.7 5.1

Employed Not included in final model -3.7

>High school education 2.4 3.5

Current drug user 13.1 .90

CD4 > 200 Not included in final model Not included in final model

Suppressed viral load Not included in final model Not included in final model

Depression 5.9 Not included in final model

On HAART Not included in final model Not included in final model

Association between Problems/Cohesion and Food/Housing security, accounting for other variables

*Bold is statistically significant p < 0.05

Results (7) Multivariable confounder model

Coefficient Problems CohesionLife satisfaction Not included in final model 2.3

Health worries Not included in final model -0.76

Financial worries -0.03 0.39

HIV mastery Not included in final model Not included in final model

Disclosure worries Not included in final model Not included in final model

Provider trust 0.002 1.54

Sexual function Not included in final model Not included in final model

Overall function Not included in final model Not included in final model

Medication concerns Not included in final model Not included in final model

Association between Problems/Cohesion and Food/Housing security, accounting for other variables

*Bold is statistically significant p < 0.05

Results (8): Multivariate logistic model

Odds of feeling much BETTER off

Unadjusted OR (95%CI)

Adjusted OR (95%CI)

Food secure 2.00 (1.35-2.96) 1.44 (0.90-2.30)

Stable housing 0.69 (0.47-1.00) 0.60 (0.40-0.90)

Depression 0.60 (0.42-0.87) 0.77 (0.52-1.14)

QoL Overall function 1.09 (1.01-1.17)

QoL Life satisfaction 1.17 (1.07-1.29)

QoL Health worries 1.08 (1.01-1.16)

QoL Financial worries 1.24 (1.15-1.34) 1.19 (1.09-1.29)

*Bold is statistically significant p < 0.05

Conclusions

Neighbourhood Perceptions

Social factors

• Food security

• Stable housing

• Gender

• Employment

• Education

• Drug use

• QoLife Components

• CD4

• Viral load suppression

• Depression

• On HAART

All HIV health variables showed statistically significant associations with

food security and stable housing

Conclusions

Neighbourhood Perceptions

Social factors

All HIV health variables showed statistically significant associations with food security and stable housing

Food security and stable housing are key factors influencing perceptions of neighbourhood quality and cohesion

• Problems

• Cohesion

• Standard of Living

• Food security

• Stable housing

• Gender

• Employment

• Education

• Drug use

• QoLife Components

Conclusions

Neighbourhood Perceptions

Social factors

All HIV health variables showed statistically significant associations with food security and stable housing

Food security and stable housing are key factors influencing perceptions of neighbourhood quality and cohesion

Further research needed to understand the causal relationships between

neighbourhood perceptions and clinical measures

• Problems

• Cohesion

• Standard of Living

• CD4

• Viral load suppression

• Depression

• On HAART

All clinical measures and other social factors showed statistically significant associations with food security and stable housing

Further research needed to better understand the causal relationships between neighbourhood perceptions and clinical measures

Recommendations

Thank You