Food insufficiency, housing and health-related quality of life: results from the Positive Spaces, Healthy Places study

Abstract

Studies of people living with HIV who are homeless or unstably housed show a high prevalence of food insufficiency (>50%) and associated poor health outcomes; however, most evidence is in the form of cross-sectional studies. To better understand this issue, we conducted a longitudinal study to examine the impact of food insufficiency and housing instability on overall physical and mental health-related quality of life (HRQoL) among people living with HIV in Ontario. Six hundred and two adults living with HIV were enrolled in the Positive Spaces, Healthy Places study and followed from 2006 to 2009. Interviewer-administered questionnaires were used, and generalized linear mixed-effects models constructed to examine longitudinal associations between food insufficiency, housing instability and physical and mental HRQoL. At baseline, 57% of participants were classified as food insufficient. After adjusting for potential confounders, longitudinal analyses revealed a significant, negative association between food insufficiency and physical and mental HRQoL outcomes, respectively [effect size (ES) with 95% confidence interval (CI): (ES = -2.1, CI = -3.9,-0.3); (ES = -3.5, CI = -6.1,-1.5)]. Furthermore, difficulties meeting housing costs were shown to have additional negative impacts on mental HRQoL. Food insufficiency is highly prevalent among people living with HIV in Ontario, particularly for those with unstable housing. This vulnerable group of individuals is in urgent need of changes to current housing programmes, services and policies, as well as careful consideration of their unmet nutritional needs.

Unmet basic needs negatively affect health-related quality of life in people aging with HIV: results from the Positive Spaces, Healthy Places study

“…Literature reviews of adults with HIV indicate that they face many challenges associated with health and well-being. These challenges encompass socioeconomics [ 5 , 6 ], depression [ 7 ], housing [ 8 ] and food security [ 9 , 10 ]. Older adults with HIV experience similar challenges [ 11 – 14 ].…”

Health-related quality of life of people living with HIV/AIDS: the role of social inequalities and disease-related factors

“…For instance, age-speci c physical health strengthening activities for adults over 25 years of age improve physical HRQoL. Faith-based behavioural and physical intervention strategies improve religious determinants of poor physical HRQoL, and tackling the issue of unemployment and food insecurity improves the physical HRQoL [42,40,50]. In addition, addressing social inequality brought about by unemployment, food insecurity and poor asset possession can enhance mental HRQoL.…”

“…Our study shows that unemployed PLWHAs are nearly twice more likely to have poor PHS scores. Likewise, it has been shown that unemployment leads to poor QoL among PLWHA in both developed and developing countries [13,18,50]. A study in Ethiopia has found that unemployed PLWHA are twice as likely to have poor physical HRQoL than employed PLWHA [23].…”

Tackling the social and structural drivers of HIV in Canada

“…Research in the United States and Canada has identified similar impacts related to food insecurity (12−14). People with HIV who are food insecure are less likely to have undetectable viral loads and have higher morbidity and mortality, and poorer physical and mental health-related quality of life (15). They miss more primary care appointments and make less use of HIV treatment.…”