Female gender predicts lower access and adherence to antiretroviral therapy in a setting of free healthcare

Abstract

BackgroundBarriers to HIV treatment among injection drug users (IDU) are a major public health concern. However, there remain few long-term studies investigating key demographic and behavioral factors - and gender differences in particular - that may pose barriers to antiretroviral therapy (ART), especially in settings with universal healthcare. We evaluated access and adherence to ART in a long-term cohort of HIV-positive IDU in a setting where medical care and antiretroviral therapy are provided free of charge through a universal healthcare system.MethodsWe evaluated baseline antiretroviral use and subsequent adherence to ART among a Canadian cohort of HIV-positive IDU. We used generalized estimating equation logistic regression to evaluate factors associated with 95% adherence to antiretroviral therapy estimated based on prescription refill compliance.ResultsBetween May 1996 and April 2008, 545 IDU participants were followed for a median of 23.8 months (Inter-quartile range: 8.5 - 91.6), among whom 341 (63%) were male and 204 (37%) were female. Within the six-month period prior to the baseline interview, 133 (39%) men and 62 (30%) women were on ART (p = 0.042). After adjusting for clinical characteristics as well as drug use patterns measured longitudinally throughout follow-up, female gender was independently associated with a lower likelihood of being 95% adherent to ART (Odds Ratio [OR] = 0.70; 95% Confidence Interval: 0.53-0.93).ConclusionsDespite universal access to free HIV treatment and medical care, female IDU were less likely to access and adhere to antiretroviral therapy, a finding that was independent of drug use and clinical characteristics. These data suggest that interventions to improve access to HIV treatment among IDU must be tailored to address unique barriers to antiretroviral therapy faced by female IDU.

Sociodemographic and Nutritional Factors Associated with Adherence to Antiretroviral Therapy in PLWHA in Benin

“…In contrast, a study among Canadian cohort of HIV-positive, authors reported that female gender was independently associated with a lower likelihood of being adherent to ART (OR = 0.70; 95% Cl: 0.53-0.93), after adjusting for clinical characteristics as well as drug use patterns measured longitudinally throughout follow-up [17].…”

Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis

“…Previous Canadian studies have shown that women experience poorer HIV-related clinical outcomes compared with men, mediated by suboptimal engagement and retention within HIV services and lower adherence to antiretroviral therapy. [18][19][20][21]25,26 Inconsistent condom use among women living with HIV is well-described in the literature, attributed to fertility desire and serocondordant partnerships, in addition to challenges negotiating condom use, including gendered power imbalances, fear of inadvertent status disclosure and the threat of violence. [27][28][29][30] Marginalized women living with HIV may experience additional social-structural barriers to insisting upon safer sex practices, particularly those who are economically disadvantaged and who engage in survival sex work, 8,31,32 compromising their ability to avoid criminal liability for HIV nondisclosure through both achievement of a low viral load and condom use.…”

1st metatarsophalangeal joint fusion: A comparison of non-union and gender differences between locking and non-locking plating systems

“…To the best of the authors' knowledge there is no study comparing fusion rates of 1st MTPJ arthrodesis in male and female patients. However, treatment adherence comparisons by gender have been made in other medical specialties and demonstrate conflicting results [27,28]. It is understood that a successful arthrodesis is a balance between fusion of the joint and implant failure.…”