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Employment predicts decreased mortality among HIV-seropositive illicit drug users in a setting of universal HIV care

British Columbia Centre for Excellence in HIV/AIDS

Objective: Given the link between employment and mortality in the general population, we sought to assess this relationship among HIV-positive people who use illicit drugs (PWUD) in Vancouver, Canada. Methods: Data were derived from a prospective cohort study of HIV seropositive PWUD (n=666) during the period of May 1996-June 2010 linked to comprehensive clinical data in Vancouver, Canada, a setting where HIV care is delivered without charge. We estimated the relationship between employment and mortality using proportional hazards survival analysis, adjusting for relevant behavioural, clinical, social and structural factors. Results: In a multivariate survival model, a time-updated measure of full time, temporary or self-employment compared to no employment was significantly associated with a lower risk of death (adjusted hazard ratio = 0.44, 95% CI: 0.22-0.91). Results were robust to adjustment for relevant confounders, including age, injection and non-injection drug use, baseline CD4+ T-cell count and baseline plasma viral load. Conclusions: These findings suggest that employment may be an important dimension of mortality risk of HIV-seropositive illicit drug users. The potentially health-promoting impacts of labour market involvement warrant further exploration given the widespread barriers to employment among this highly marginalized population and persistently elevated levels of preventable mortality.

Article; Postprint

eng

Vancouver : University of British Columbia Library

10.14288/1.0347276

Medicine, Faculty of; Other UBC; Non UBC; Medicine, Department of; Sociology, Department of; Arts, Faculty of

10.1136/jech-2013-202918

Faculty

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