Mina Kazemi, Student, Women's College Research Institute, Toronto, ON, Canada
Nadine Kronfli, Resident, McMaster University, Department of Infectious Diseases, Toronto, ON, Canada
Carmen Logie, MSW, PhD, Assistant Professor, University of Toronto, Toronto, ON, Canada
Yasmeen Persad, Research Associate, Women's College Research Institute, Toronto, ON, Canada
Kerrigan Beaver, Research Associate, Women's College Research Institute, Toronto, ON, Canada
Marisol Desbiens, Research Associate, Women's College Research Institute, Toronto, ON, Canada
Allison Carter, Doctoral Student, Simon Fraser University, Burnaby, BC, Canada
Allison Carlson, Research Coordinator, Women's College Research Institute, Toronto, ON, Canada
Muna Aden, Research Coordinator, Women's College Research Institute, Toronto, ON, Canada
Anita Benoit, Assistant Professor, University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada
Mandy Mack, Research Associate, Women's College Research Institute, Toronto, ON, Canada
Art Zoccole, Executive Director, 2-Spirited People of the First Nations, Toronto, ON, Canada
Wangari Tharao, MPH, PhD Candidate, Research Director, Women's Health in Women's Hands Community Health Centre, Toronto, ON, Canada
V. Logan Kennedy, Co-Investigator, Women's College Research Institute, Toronto, ON, Canada
Ann Burchell, Assistant Professor, University of Toronto, Dalla Lana School of Public Health; St. Michael's Hospital, Centre for Research on Inner City Health, Toronto, ON, Canada
Angela Kaida, Assistant Professor, Simon Fraser Univesrsity, Burnaby, BC, Canada
Alexandra de Pokomandy, Assistant Professor, McGill University Health Centre, Department of Family Medicine, Montreal, QC, Canada
Robert Hogg, Professor, Simon Fraser University, Faculty of Health Sciences, Burnaby, BC, Canada
Mona Loutfy, MPH, MD, Research Scientist, University of Toronto, Toronto, ON, Canada
Background and Purpose: Timely entry into HIV-related healthcare is necessary to optimize the health and well-being of women with HIV. Individual, social, and structural barriers may influence access to HIV-related healthcare within urban contexts of high service availability. Urban environments are characterized by greater racial/ethnic, sexual, and gender diversity compared to rural environments, increasing the likelihood that women with HIV experience intersecting oppression based on race, sexual orientation, and gender identity. Context-specific analyses are necessary to inform social work interventions to address access disparities for urban women with HIV. This study seeks to identify multilevel correlates of delayed access to HIV-related care among women with HIV from a large urban centre in Canada.
Methods: We analysed baseline survey data of urban women from the Canadian HIV Women’s Sexual and Reproductive Health Study (CHIWOS), a community-based participatory longitudinal cohort study (n=294/1425). The outcome variable examined in this study was delayed access to HIV-related care, defined as greater than 3 months between time of diagnosis and time of first access. We conducted bivariate analyses using chi-square and ANOVA to explore the association between sociodemographic (e.g., age, gender identity), individual (e.g., resiliency, depression), social (e.g., social support), structural (e.g., HIV-related stigma, racism), and health factors (e.g., CD4 count) and delayed access to HIV-related care. A multivariate logistic regression model was then built by entering all time-invariant variables with a bivariate p-value <0.20.
Results: One-quarter (n=75, 25.5%) of women from this urban sample reported delayed access to HIV-related care. Women with delayed access to care had higher depression (CES-D) [F(1,284)=5.71, p<.05)] and lower resiliency (RS-10) [F(1,290)=8.42, p<.01], social support (MOS-SSS) [F(1,284)=13.14, p<.001], physical health (SF-12) [F(1,288)=3.94, p<.05], and mental health (SF-12) [F(1,288)=15.68, p<.001] scores, compared to women with timely access to care. In multivariate analyses, women diagnosed greater than or equal to 6 years ago had higher odds of delayed access to care [OR: 5.3, 95% CI: 2.5-11.2] compared to those diagnosed less than 6 years ago and women of non-white ethnicity (Black, Aboriginal, and other ethnicities) had higher odds of delayed access to care [OR: 2.1, 95% CI: 1.1-4.0] compared to Caucasian women.
Conclusions and Implications: Our findings document multilevel factors associated with delayed access to care for urban women with HIV. Social workers are well-positioned to implement interventions to address depression, build resiliency, and facilitate connection to social support among newly diagnosed women with HIV, which may improve timely access to HIV-related care for these women. Social workers may also address depression and social isolation of women living with HIV through continual efforts to reduce HIV-related stigma at individual and structural levels. Further research is necessary to understand racial/ethnic disparities in delayed access to care and to optimize the health and well-being of all women living with HIV.
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