Alexis Palmer Drug Treatment Program BC 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 Insecure71% Unstable Housing35% Male76% Currently Employed23% High school Education or Greater56% Illicit Drug Use Never Drugs Yes, Not Current Current 14.5% 37.3% 48.2% Age (median)45.7 ( )

Results (2) Social factors Mean scoresProblemsCohesion Food secure 23 vs 4164 vs 54 Stable housing 29 vs 4960 vs 51 Male 34 vs 4358 vs 53 Employed 26 vs 3961 vs 56 >High school education 34 vs 3960 vs 54 Current drug user 47 vs 2654 vs 60 *Bold is statistically significant p < 0.05

Results (3) Social factors Percentages Standard of Living BetterSameWorse Food secure YNYN 39% 26% 48% 47% 13% 27% Stable housing YNYN 28% 34% 47% 25% 19% Male YNYN 30% 32% 48% 42% 22% 26% Employed YNYN 31% 30% 52% 45% 17% 25% >High school education YNYN 29% 31% 50% 43% 21% 26% Current drug user YNYN 32% 28% 47% 21% 25% *Bold is statistically significant p < 0.05

Results (4) HIV health Mean scoresProblemsCohesion CD4 > vs vs 56 Suppressed viral load 33 vs vs 55 Depression 42 vs 2854 vs 61 On HAART 35 vs vs 56 *Bold is statistically significant p < 0.05

Results (5) HIV health Percentages Standard of Living BetterSameWorse CD4 > % 29% 48% 43% 22% 28% Suppressed viral load 31% 28% 48% 21% 24% Depression 27% 34% 45% 50% 28% 16% On HAART 31% 25% 47% 45% 22% 30% *Bold is statistically significant p < 0.05

Results (6) Multivariable confounder model CoefficientProblemsCohesion Food secure Stable housing Male EmployedNot included in final model-3.7 >High school education Current drug user CD4 > 200Not included in final model Suppressed viral loadNot included in final model Depression 5.9 Not included in final model On HAARTNot 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 CoefficientProblemsCohesion Life satisfactionNot included in final model 2.3 Health worriesNot included in final model Financial worries HIV masteryNot included in final model Disclosure worriesNot included in final model Provider trust Sexual functionNot included in final model Overall functionNot included in final model Medication concernsNot 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 secure2.00 ( )1.44 ( ) Stable housing 0.69 ( )0.60 ( ) Depression0.60 ( )0.77 ( ) QoL Overall function1.09 ( ) QoL Life satisfaction1.17 ( ) QoL Health worries1.08 ( ) QoL Financial worries 1.24 ( )1.19 ( ) *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

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