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The impact of structural inequities and interpersonal violence on food security and HIV care among women living with and affected by HIV in a Canadian setting

University of British Columbia

BACKGROUND: Women living with HIV (WLWH) and sex workers (SWs) are priority populations for HIV prevention, diagnosis, treatment, and care. There is limited research into the impacts of structural (e.g., laws) and interpersonal violence (i.e., physical, sexual, verbal) on access to necessities (e.g., food, housing), HIV treatment, or the relationship between violence and HIV stigma. This thesis investigated the role of structural and interpersonal violence in an environment of HIV non-disclosure criminalization, in food insecurity among SWs living with and affected by HIV, and in antiretroviral (ART) adherence. METHODS: Data were drawn from two community-based prospective cohort studies, An Evaluation of Sex Workers’ Health Access (AESHA) and Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA). Bivariate and multivariable logistic regression were used to examine the correlates of physical and/or verbal violence due to HIV disclosure without consent among WLWH in the SHAWNA cohort. Bivariate and multivariable logistic regression using generalized estimating equations (GEE) were used to model correlates of food insecurity among SWs in the AESHA cohort. Finally, a multivariable confounder model was created to assess the independent relationship between ART adherence and physical and/or sexual violence for WLWH in the SHAWNA cohort. RESULTS: Among 255 WLWH enrolled in SHAWNA between 2010-2016, bivariate and multivariable logistic regression showed that WLWH who were “outed” had elevated odds of experiencing physical and/or verbal violence (Objective 1). In AESHA, among 761 SWs living with or affected by HIV between 2010-2014, bivariate and multivariable logistic regression using GEE revealed increased odds of food insecurity for SWs who experienced physical and/or sexual violence (Objective 2). Among 250 WLWH enrolled in SHAWNA between 2014-2017, bivariate and multivariable logistic regression using GEE found decreased odds of optimal ART adherence among WLWH who experienced physical and/or sexual violence (Objective 3). CONCLUSIONS: Structural and interpersonal violence are important factors in the health needs and outcomes of SWs and WLWH. Universally applied trauma-informed care by primary healthcare providers is crucial. The decriminalization of sex work and HIV non-disclosure must be a priority. Given the high proportion of Indigenous women represented in this thesis, culturally relevant programming must be accessible.

Thesis/Dissertation

eng

Vancouver : University of British Columbia Library

10.14288/1.0357238

Master of Science - MSc

Medicine, Faculty of; Population and Public Health (SPPH), School of

2017-11

Graduate

DSpace