Longitudinal associations between social determinants of health and well-being among women living with HIV in Canada: A latent class analysis

Zerihun Admassu; Carmen H Logie; Luissa Vahedi; Angela Underhill; Logan Kennedy; Kath Webster; Brenda Gagnier; Angela Kaida; Alexandra de Pokomandy; Mona R Loutfy

doi:10.1111/hiv.70031

Longitudinal associations between social determinants of health and well-being among women living with HIV in Canada: A latent class analysis

HIV Med. 2025 Apr 14. doi: 10.1111/hiv.70031. Online ahead of print.

Authors

Zerihun Admassu¹, Carmen H Logie^{1

2

3}, Luissa Vahedi¹, Angela Underhill², Logan Kennedy², Kath Webster², Brenda Gagnier², Angela Kaida⁴, Alexandra de Pokomandy^{5

6}, Mona R Loutfy^{2

7

8}

Affiliations

¹ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
² Research and Innovation Institute, Women's College Hospital, Toronto, Ontario, Canada.
³ Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada.
⁴ Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.
⁵ Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
⁶ McGill University Health Centre, Montreal, Quebec, Canada.
⁷ Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada.

PMID: 40228794
DOI: 10.1111/hiv.70031

Abstract

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 (aβ = 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 (aβ = 3.42; 95% CI: 1.72, 5.12; p < 0.001) and gender discrimination (aβ = 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.

Keywords: HIV; social determinants of health; well‐being; women.

Abstract

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