Working people living with HIV: who are they?

Lavoie, René1; Otis, Joanne2,3; Godin, Gaston4,5

and the MAA Study Group 1 COCQ-SIDA

2 Department of Sexology, Université du Québec à Montréal3 Canada Research Chair in Health Education

4 Department of Nursing, Université Laval5 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 pNo (%)

(n=513)Yes (%)

(n=328) Age (< 45 years) 50.3 58.7 0.02Gender (Men) 80.1 82,6 nsSexual orientation (homosexual/bisexual)

51.8 73.4 0.0001

Language (French) 79.7 75.3 nsEducation (≥ High school) 43.1 64.0 0.0001Born in Quebec (yes) 75.4 69.2 0.05Country of birth (other than Canada) 18.5 23.5 0.08HIV endemic country of origin (yes) 10.7 10.1 nsCurrently IDU (yes) 19.9 5.2 0.0001

ResultsSocio-demographic characteristics (continued)

Variables Currently working pNo (%)

(n=513)Yes (%)

(n=328) Single (yes) 65.3 55.2 0.003Live alone (yes) 45.9 41.9 nsChildren (no) 64.7 75.0 0.002Income (> 15 000$) 29.3 77.5 0.0001Participate in volunteer work (yes) 18.4 14.6 nsParticipate in organization’s activities (yes)

33.0 27.5 0.09

ResultsIllness and treatment trajectories

Variables Currently working pNo

(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 nsLifespan with Tx (years) (M) 6.58 6.14 nsNumber of symptoms (M) 11.26 8.99 0.0001

M=mean

ResultsSexual behaviours

Variables Currently working pNo (%)

(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 pNo (M)

(n=513)Yes (M)(n=328)

Quality of life (total) 4.86 5.41 0.0001QoL: Physical functioning 5.31 6.14 0.0001QoL: Social functioning 4.38 5.21 0.0001QoL: Social support 4.74 5.36 0.0001QoL: Cognitive functioning 5.14 5.67 0.0001QoL: Financial situation 4.94 5.55 0.0001Scale varying from (1) « very low » to (7) « very high »

(M) = Mean

ResultsQuality of life (continued)

Variables Currently working pNo (M)

(n=513)Yes (M)

(n=328) QoL: Partner 5.34 5.60 0.04QoL: Sexual functioning 4.46 4.60 nsQoL: Health care 5.54 5.81 0.005QoL: Mental health 4.15 4.64 0.0001QoL: Physical health 5.02 5.66 0.0001Scale varying from (1) « very low » to (7) « very high »

(M) = Mean

ResultsAnxiety and depression

Variables Currently working pNo (M)

(n=513)Yes (M)

(n=328) Anxiety & depression 1.99 1.75 0.0001Depression 1.83 1.56 0.0001Anxiety 2.16 1.94 0.0001

Scale varying from (1) « very low » to (4) « very high »

(M) = Mean

ResultsCoping strategies

Variables Currently working pNo (M)

(n=513)Yes (M)

(n=328) Coping: Denial 1.66 1.47 0.0001Coping: Recreational 2.42 2.27 0.01Coping: To be Active 2.87 2.94 nsCoping: Support from partner 2.56 2.41 nsCoping: Support from friends 2.24 2.25 nsCoping: Religion 2.45 2.15 0.0001Coping: Humour 2.10 2.13 nsCoping: 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