working people living with hiv: who are they? lavoie, rené 1 ; otis, joanne 2,3 ; godin, gaston 4,5...
TRANSCRIPT
Working people living with HIV: who are they?
Lavoie, René1; Otis, Joanne2,3; Godin, Gaston4,5
and the MAA Study Group
1 COCQ-SIDA2 Department of Sexology, Université du Québec à Montréal
3 Canada Research Chair in Health Education4 Department of Nursing, Université Laval
5 Canada Research Chair on Behaviours and Health
Annual Canadian Conference on HIV/AIDS ResearchCAHR
Quebec, May 27th 2006
Study funded by the CIHR HHP-64511
MAA Study Group Maria Victoria Zunzunegui, co-
investigator, Département de médecine sociale et préventive, Université de Montréal
José Côté, co-investigator, Faculté des sciences infirmières, Université de Montréal
Michel Alary, co-investigator, Unité de recherche sur la santé des populations, Hôpital du Saint-Sacrement du CHA
Eduard Beck, co-investigator, Direction de santé publique Montréal-Centre
Pierre Côté, co-investigator, Clinique médicale du Quartier Latin
Joseph J. Cox, co-investigator, Centre de traitement de l’immunodéficience, Hôpital général de Montréal
André Dascal, co-investigator, Maladies infectieuses et microbiologie, Hôpital général Juif SMBD
Neil Gaul, collaborator, Département de médecine familiale, Hôpital Maisonneuve-Rosemont
Richard Lalonde, collaborator, Institut thoracique de Montréal
Normand Lapointe, co-investigator, Centre maternel et infantile sur le sida, Hôpital Sainte-Justine
René Lavoie, co-investigator, COCQ-sida Roger LeBlanc, collaborator, Clinique
médicale Projet L.O.R.I Nima Machouf, co-investigator, Montreal
CHEST Institute Danielle Rouleau, co-investigator,
Département de microbiologie médicale et infectiologie, Hôpital Notre-Dame du CHUM
Emil Toma, co-investigator, Département de microbiologie médicale et infectiologie, Hôpital Hôtel-Dieu du CHUM
Benoît Trottier, collaborator, Clinique médicale de l’Actuel
Jean Vincelette, co-investigator, Département de microbiologie médicale et infectiologie, Hôpital Saint-Luc du CHUM
Study Objective
To describe the socio-demographic,psychosocial and sexualcharacteristics of workingpeople living with HIV
(PLWHIV).
Methodology Data were gathered from MAA, an ongoing longitudinal
study documenting the quality of life (QoL) and associated factors among PLWHIV.
Recruitment undertaken through the 11 collaborating clinical sites and with the help of community groups
Participants were seen at 6-month intervals (T0, T1, T2, T3) Face-to-face interviews Consultation of medical files for CD4 and viral load results
842 participants were recruited (at baseline) from November 2004 to April 2006: Men = 81.1% Heterosexual = 39.8% Mean age = 44.1 years Currently working = 39.0%
Methodology
Study variables Socio-demographic characteristics (gender, age, education,
annual income, sexual orientation, etc.) Illness trajectory (transmission, lifespan with HIV, lifespan
with Tx, number of symptoms, etc.) Anxiety and depression (HAD scale; 2 subscales; Zigmond &
Snaith, 1983) Coping strategies (COPE scale; 8 subscales; Carver et al.,
1989) Quality Of Life (MQoL-HIV scale and 10 subscales; New
England Research Institutes, 1991) Sexual behaviours (sexual relations with penetration,
unprotected sex with HIV- or HIV? partners, type of partners)
Analyses
Bivariate analyses: Pearson’s Chi2 tests, Student’s t-test
Multivariate analysis: logistic regression (method: stepwise) on working status (yes, no)
ResultsSocio-demographic characteristics
Variables Currently working p
No (%)(n=513)
Yes (%)(n=328)
Age (< 45 years) 50.3 58.7 0.02
Gender (Men) 80.1 82,6 ns
Sexual orientation (homosexual/bisexual)
51.8 73.4 0.0001
Language (French) 79.7 75.3 ns
Education (≥ High school) 43.1 64.0 0.0001
Born in Quebec (yes) 75.4 69.2 0.05
Country of birth (other than Canada) 18.5 23.5 0.08
HIV endemic country of origin (yes) 10.7 10.1 ns
Currently IDU (yes) 19.9 5.2 0.0001
ResultsSocio-demographic characteristics (continued)
Variables Currently working p
No (%)(n=513)
Yes (%)(n=328)
Single (yes) 65.3 55.2 0.003
Live alone (yes) 45.9 41.9 ns
Children (no) 64.7 75.0 0.002
Income (> 15 000$) 29.3 77.5 0.0001
Participate in volunteer work (yes) 18.4 14.6 ns
Participate in organization’s activities (yes)
33.0 27.5 0.09
ResultsIllness and treatment trajectories
Variables Currently working p
No (n=513)
Yes (n=328)
Sexual transmission of HIV (yes) (%)
71.4 87.8 0.0001
Transmission through injection drug use (yes) (%)
27.1 8.8 0.0001
Currently undergoing Tx (yes) (%) 83.6 84.4 ns
Lifespan with HIV (years) (M) 9.97 9.46 ns
Lifespan with Tx (years) (M) 6.58 6.14 ns
Number of symptoms (M) 11.26 8.99 0.0001
M=mean
ResultsSexual behaviours
Variables Currently working p
No (%)(n=513)
Yes (%)(n=328)
Sexual intercourse in the last 6 months (Yes)
47.0 65.9 0.0001
Risky sexual intercourse in the last 6 months (Yes) (HIV- or HIV?)
15.2 22.2 0.01
Unprotected sexual intercourse in the last 6 months (Yes) (irrespective of HIV status of partner)
21.2 30.6 0.002
ResultsQuality of life
Variables Currently working p
No (M)(n=513)
Yes (M)(n=328)
Quality of life (total) 4.86 5.41 0.0001
QoL: Physical functioning 5.31 6.14 0.0001
QoL: Social functioning 4.38 5.21 0.0001
QoL: Social support 4.74 5.36 0.0001
QoL: Cognitive functioning 5.14 5.67 0.0001
QoL: Financial situation 4.94 5.55 0.0001
Scale varying from (1) « very low » to (7) « very high »
(M) = Mean
ResultsQuality of life (continued)
Variables Currently working p
No (M)(n=513)
Yes (M)(n=328)
QoL: Partner 5.34 5.60 0.04
QoL: Sexual functioning 4.46 4.60 ns
QoL: Health care 5.54 5.81 0.005
QoL: Mental health 4.15 4.64 0.0001
QoL: Physical health 5.02 5.66 0.0001
Scale varying from (1) « very low » to (7) « very high »
(M) = Mean
ResultsAnxiety and depression
Variables Currently working p
No (M)(n=513)
Yes (M)(n=328)
Anxiety & depression 1.99 1.75 0.0001
Depression 1.83 1.56 0.0001
Anxiety 2.16 1.94 0.0001
Scale varying from (1) « very low » to (4) « very high »
(M) = Mean
ResultsCoping strategies
Variables Currently working p
No (M)(n=513)
Yes (M)(n=328)
Coping: Denial 1.66 1.47 0.0001
Coping: Recreational 2.42 2.27 0.01
Coping: To be Active 2.87 2.94 ns
Coping: Support from partner 2.56 2.41 ns
Coping: Support from friends 2.24 2.25 ns
Coping: Religion 2.45 2.15 0.0001
Coping: Humour 2.10 2.13 ns
Coping: Substance use 1.79 1.44 0.0001
Scale varying from (1) « never » to (4) « very often »
(M) = Mean
ResultsMultivariate analysis
Working PLWHIV were: More likely to have a level of education higher than high
school Adjusted O.R. = 1.73; 95% CI = 1.24-2.42
More likely to be gay or bisexual Adjusted O.R. = 1.90; 95% CI = 1.32-2.74
Less likely to have contracted HIV through injection drug use Adjusted O.R. = 0.52; 95% CI = 0.31-0.86
More likely to have had penetrative sex in the last six months Adjusted O.R. = 1.98; 95%CI = 1.42-2.76
ResultsMultivariate analysis (continued)
Working PLHIV were:
Less likely to use religion as a CS Adjusted O.R. = 0.86; 95% CI = 0.73-0.99
More likely to have a higher level of physical functioning Adjusted O.R. = 1.39; 95% CI = 1.20-1.61
More likely to have a higher level of social functioning Adjusted O.R. = 1.27; 95% CI = 1.12-1.43
More likely to have fewer symptoms Adjusted O.R. = 0.96; 95% CI = 0.92-0.99
Conclusion Distinction between working PLWHIV and non
working PLWHIV does not seem to be directly explained by illness trajectory currently undergoing Tx (ns) lifespan with Tx (ns) lifespan with HIV (ns)
Need for more investigation in order to verify the associations between working status, CD4 count level and viral load
Conclusion (continued…)
However, having a job appears to be associated with several factors including the quality of life, in particular regarding physical and social functioning
It remains to be documented if working status is an antecedent or a consequence of improved quality of life
Conclusion
These findings concerning working status in PLWHIV are similar to other results of research conducted in France (Dr Delfraissy, ANRS, Journées Québécoises VIH, 2006)
Considering these findings, new questions have been included in the MAA study questionnaires in order to furthur pursue this line of research
We would like to take this opportunity to thank all the participants, as well as
community organizations and research staff who devoted their time
and efforts to make this study possible