Objective: Given that people who use illicit drugs (PWUD)
often engage in prohibited income generation to support their basic needs, we
sought to examine the role of these activities in shaping antiretroviral
therapy (ART) adherence and plasma HIV RNA-1 viral load suppression among
HIV-infected PWUD.
Design: Longitudinal analyses among HIV-positive,
ART-exposed PWUD in the AIDS Care Cohort to evaluate Exposure to Survival
Services prospective cohort study (2005–2013).
Methods: Generalized linear mixed-effects and mediation
analyses examined the relationship between prohibited income generation (e.g.,
sex work, drug dealing, theft, street-based income) and virologic suppression
(plasma viral load ≤50 copies/ml plasma) adjusting for adherence and potential
confounders.
Results: Among 687 HIV-infected PWUD, 391 (56.9%)
individuals reported prohibited income generation activity during the study
period. In multivariate analyses, prohibited income generation remained
independently and negatively associated with virologic suppression (adjusted
odds ratio: 0.68, 95% confidence interval: 0.52–0.88) following adjustment for
hypothesized confounders, including high-intensity drug use, ART adherence and
homelessness. Although partially mediated by ART adherence, the relationship
between prohibited income generation and virologic suppression was maintained
in mediation analyses (Sobel statistic = −1.95, P = 0.05).
Conclusion: Involvement in prohibited income generation
decreases the likelihood of virologic suppression directly and indirectly
through its negative association with ART adherence. These findings suggest
that linkages between socioeconomic marginalization, the criminalization of
illicit drug use, and insufficient employment opportunities may produce barriers
to access and retention in care. Programmatic and policy interventions that
decrease socioeconomic vulnerability may therefore reduce HIV-related
morbidity, mortality, and onward transmission.
Purchase full article at: http://goo.gl/IdzxuO
By: Richardson, Lindsey A.a,b; Kerr, Thomas H.a,c; Dobrer, Sabinaa; Puskas, Cathy M.a,d; Guillemi, Silvia A.a; Montaner, Julio S.G.a,c; Wood, Evana,c; Milloy, M.-J.S.a,c
aBritish Columbia Centre for Excellence in HIV/AIDS bDepartment of Sociology cDivision of AIDS, Department of Medicine, University of British Columbia, Vancouver dFaculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
More at: https://twitter.com/hiv_insight
No comments:
Post a Comment