alexis palmer drug treatment program bc centre for excellence in hiv/aids
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Home is where the HAART is: An examination of the factors affecting neighbourhood perception for people living with HIV/AIDS. Alexis Palmer Drug Treatment Program BC Centre for Excellence in HIV/AIDS. Background. Food security Stable housing Gender Employment Education Drug use - PowerPoint PPT PresentationTRANSCRIPT
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