Background: Social determinants of health (SDoH) can significantly impact overall well-being. While existing research has explored SDoH as predictors of well-being among women living with HIV, longitudinal studies examining these relationships over time remain limited. We examined SDoH typologies among women living with HIV in Canada and longitudinal associations with well-being. Methods: Using longitudinal survey data collected at three time points from women living with HIV in Canada (2013-2018), we conducted latent class analysis (LCA) to identify subgroups of SDoH indicators, including income, experiences of violence, food security, substance use, housing stability, HIV-related stigma and social support at baseline (Time-1). Multivariable linear and logistic regression examined associations between SDoH classes and well-being (depression, discrimination [gender, racial] and HIV clinical outcomes [viral load, adherence, HIV care barriers]) at Time-3. Results: We identified three distinct SDoH classes among participants (n = 1422, mean age = 42.8): high (n = 435; 30.6%), medium (n = 377; 26.5%) and low SDoH adversity (n = 610; 42.9%). In multivariate regression analyses, the high SDoH adversity class had lower odds of achieving an undetectable viral load (adjusted Odds Ratio [aOR] = 0.46; 95% CI: 0.21, 1.01; p = 0.050) and higher probability of facing barriers to accessing care (a beta = 0.32; 95% CI: 0.19, 0.45; p < 0.001), depression (aOR = 2.52; 95% CI: 1.71, 3.71; p < 0.001), racial discrimination (a beta = 3.42; 95% CI: 1.72, 5.12; p < 0.001) and gender discrimination (a beta = 3.14; 95% CI: 1.42, 4.87; p < 0.001), compared with the low SDoH adversity class at 5-year follow-up. Conclusions: SDoH adversities were associated with poor wellbeing among women living with HIV in Canada. Integrated, comprehensive person-centred care approaches that address SDoH are needed to improve health and wellbeing.
[1]Univ Toronto, Factor Inwentash Fac Social Work, Toronto, ON M5S 1V4, Canada.
[2]Womens Coll Hosp, Res & Innovat Inst, Toronto, ON, Canada.
[3]Ctr Gender & Sexual Hlth Equ, Vancouver, BC, Canada.
[4]Simon Fraser Univ, Fac Hlth Sci, Vancouver, BC, Canada.
[5]McGill Univ, Dept Family Med, Montreal, PQ, Canada.
[6]McGill Univ, Hlth Ctr, Montreal, PQ, Canada.
[7]Univ Toronto, Fac Med, Toronto, ON, Canada.
[8]Univ Toronto, Dalla Sch Publ Hlth, Toronto, ON, Canada.
(8.0+极速模式)