Social and Structural Barriers to Primary Care Access Among Women Living With HIV in Metro Vancouver, Canada: A Longitudinal Cohort Study

Deering, Kathleen; Chong, Louise; Duff, Patricia A.; Gurney, Lulu; Magagula, Patience; Wiedmeyer, Mei-Ling; Chettiar, Jill; Braschel, Melissa; D’Souza, Karan; Shannon, Kate

doi:10.1097/jnc.0000000000000234

Cited by 6 publications

(8 citation statements)

References 41 publications

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“…The frequent use of criminalized drugs for pain management indicates that many WLWH may have difficulty accessing pain care. A previous examination of barriers to primary care in our study context concluded that equity-oriented approaches may improve access for WLWH [ 19 ]. The EQUIP framework, which operationalizes 4 dimensions of equity-oriented care (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Previously identified psychological correlates of pain in PLWH include anxiety, depression, post-traumatic stress, and substance use disorder [ 20 , 30 , 53 , 67 ]. Sociostructural correlates of pain in PLWH are less well characterized despite evidence that social interactions modulate the experience of pain [ 34 ] and structural inequities among PLWH limit access to care [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, it is unclear whether these studies included transgender (trans) WLWH or non-binary persons, reflecting the frequent erasure of gender minority communities from health research despite the unique inequities affecting these populations [ 54 ]. We have also been unable to identify studies examining the relationship between interpersonal violence and pain in HIV although there is a documented association between violence and pain in the general population [ 78 ] and a high prevalence of violence among WLWH [ 11 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence, correlates, and quality-of-life outcomes of major or persistent pain among women living with HIV in Metro Vancouver, Canada

Ly,

Shannon,

Braschel

et al. 2024

Harm Reduct J

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While women living with HIV (WLWH) are twice as likely to report severe or undertreated chronic pain compared to men, little is known about pain among WLWH. Our goal was to characterize the correlates of pain as well as its impact on quality-of-life outcomes among women enrolled in the Sexual Health and HIV/AIDS Women’s Longitudinal Needs Assessment (SHAWNA), an open longitudinal study of WLWH accessing care in Metro Vancouver, Canada. We conducted logistic regression analyses to identify associations between self-reported major or persistent pain with sociostructural and psychosocial correlates and with quality-of-life outcomes. Data are presented as adjusted odds ratios (aORs) with 95% confidence intervals. Among 335 participants, 77.3% reported pain at ≥ 1 study visit, with 46.3% experiencing any undiagnosed pain and 53.1% managing pain with criminalized drugs. In multivariable analysis, age (aOR 1.04[1.03–1.06] per year increase), food and housing insecurity (aOR 1.54[1.08–2.19]), depression diagnosis (aOR 1.34[1.03–1.75]), suicidality (aOR 1.71[1.21–2.42]), and non-daily, non-injection opioid use (aOR 1.53[1.07–2.17]) were associated with higher odds of pain. Daily non-injection opioid use (aOR 0.46[0.22–0.96]) and health services access (aOR 0.63[0.44–0.91]) were associated with lower odds of pain. In separate multivariable confounder models, pain was associated with reduced odds of good self-rated health (aOR 0.64[0.48–0.84] and increased odds of health interference with social activities (aOR 2.21[1.63–2.99]) and general function (aOR 3.24[2.54–4.13]). In conclusion, most WLWH in our study reported major or persistent pain. Pain was commonly undiagnosed and associated with lower quality of life. We identified structural and psychosocial factors associated with pain in WLWH, emphasizing the need for low-barrier, trauma-informed, and harm reduction-based interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence, correlates, and quality-of-life outcomes of major or persistent pain among women living with HIV in Metro Vancouver, Canada

Ly,

Shannon,

Braschel

et al. 2024

Harm Reduct J

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“…Women living with HIV (WLWH) account for 18% of all people living with HIV (PLWH) in British Columbia, 1 Canada, and continue to experience unique and substantial barriers to accessing necessary health care. [2][3][4][5][6][7] WLWH can experience suboptimal and stigmatizing interactions with health care services providers by way of provision of substandard treatment, denial of health care services, excessive/unnecessary precautions taken by health care services staff, and non-consensual disclosure of patient's HIV status. [7][8][9] Discrimination and marginalization in accessing care can lead to decreased utilization of health saving services, 10,11 increased mental health issues, and poor quality of life.…”

Section: Introductionmentioning

confidence: 99%

Access to and quality of care for sexual and gender minority women living with HIV in Metro Vancouver, Canada: Results from a longitudinal cohort study

Perrin,

Shannon,

Lowik

et al. 2023

Womens Health (Lond Engl)

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Background: While scarce, literature suggests that women at the intersection of HIV status and gender and/or sexual minority identities experience heightened social and health disparities within health care systems. Objectives: This study examines the association between sexual and/or gender minority identities and: (1) experiences of poor treatment by health professionals and (2) being unable to access health services among a cohort of women living with HIV in Metro Vancouver, Canada. Design: Data were drawn from a longitudinal community–based cohort of women living with HIV (Sexual Health and HIV/AIDS Women’s Longitudinal Needs Assessment). Methods: We examined associations between sexual and/or gender minority identities and the two outcomes. We drew on explanatory variables to measure sexual minority and gender minority identities independently and a combined variable measuring sexual and/or gender minority identities. The associations between each of these three variables and each outcome were analysed using bivariate and multivariable logistic regression models with generalized estimating equations for repeated measures over time. Adjusted odds ratios and 95% confidence intervals are reported. Results: The study sample included 1460 observations on 315 participants over 4.5 years (September 2014 to February 2019). Overall, 125 (39.7%) reported poor treatment by health professionals and 102 (32.4%) reported being unable to access health care services when needed at least once over the study period. A total of 110 (34.9%) of participants reported sexual and/or gender minority identities, 106 (33.7%) reporting sexual minority identities, with 29 (9.2%) reporting gender minority identities. In multivariable analysis, adjusting for confounders, sexual minority identities, and combined sexual and/or gender minority identities were significantly associated with increased odds of experiencing poor treatment by health professionals (sexual minority adjusted odds ratio = 1.39 (0.94–2.05); sexual and/or gender minority adjusted odds ratio = 1.48 (1.00–2.18)) and being unable to access health services (sexual minority adjusted odds ratio = 1.89 (1.20–2.97); sexual and/or gender minority adjusted odds ratio = 1.91 (1.23–2.98)). In multivariable analysis, gender minority identities were not significantly associated with increased odds of experiencing poor treatment by health professionals (gender minority adjusted odds ratio = 1.38; 95% CI = 0.76–2.52) and being unable to access health services (gender minority adjusted odds ratio = 1.72; 95% CI = 0.89–3.31) possibly due to low sample size among women with gender minority identities. Conclusion: Our findings suggest the need for access to inclusive, affirming, trauma-informed health care services tailored specifically for and by women living with HIV with sexual and/or gender minority identities.

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“…Ongoing colonial violence and gender-based violence continues to impact the health and well-being of Indigenous women, Two-Spirt Peoples, sex workers, and women living with HIV ( 2 – 6 ). Historical and ongoing colonial violence has impacted Indigenous health and Indigenous women Two-Spirit Peoples, women living with HIV, and sex workers face multiple barriers to accessing reliable healthcare services ( 7 ) and people with marginalized and minoritized gender identities face increased barriers to accessing healthcare on the ancestral, occupied territories of the Musqueam, Squamish, and Tsleil-Waututh Peoples in what is now referred to as Vancouver ( 8 , 9 ). Barriers that impact health access are rooted in racism and discrimination.…”

Section: Introductionmentioning

confidence: 99%

Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic

Perry,

Goldenberg,

Deering

et al. 2023

Preprint

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Objectives Historical and ongoing colonial violence, racism, discrimination, criminalization, and intergenerational trauma continues to impact the health of Indigenous women (cisgender and transgender) and Two-Spirit Peoples. Previous and ongoing work clearly articulate the deeply harmful roles of colonialism and racism in continuing to systemically exclude Indigenous Peoples from accessing equitable and culturally safe healthcare. While the COVID-19 pandemic has amplified structural inequities, little attention has been paid to how the pandemic impacts healthcare access for Indigenous women and Two-Spirit Peoples living in urban settings. The aim of this study was to evaluate factors associated with experiencing difficulty accessing routine healthcare in a cohort of marginalized urban Indigenous women and Two-Spirit Peoples on the ancestral, occupied territories of the Musqueam, Squamish and Tsleil-Waututh Nations in what is now referred to as Metro Vancouver, Canada during the COVID-19 pandemic. Methods Data were drawn from AMPLIFY, a study of Indigenous cis and trans women and Two-Spirit Peoples in Metro Vancouver. Analyses drew on baseline and semi-annual questionnaire data collected with sex workers and women living with HIV from October 2020–August 2021. We used bivariate and multivariable logistic regression with generalized estimating equations (GEE) to model correlates of experiencing difficulty accessing a family doctor, nurse, or clinic for routine healthcare during the COVID-19 pandemic in the last 6-months. Results Amongst 142 marginalized Indigenous women and Two-Spirit Peoples (199 observations), 27.5% reported difficulty accessing routine healthcare. In multivariable GEE logistic regression, participants who had ever been pregnant (AOR:4.71, 95% CI:1.33–16.66) experienced negative changes in psychological and emotional well-being (AOR: 3.99, 95% CI: 1.33–11.98), lacked access to culturally safe health services (AOR:4.67, 95% CI:1.43–15.25), and had concerns regarding safety or violence in their community (AOR:2.72, 95% CI:1.06–6.94) had higher odds of experiencing recent difficulty accessing routine healthcare. Discussion Findings are in line with the BC Commissioned In Plain Sight report which recommends the need for accessible, culturally safe, anti-racist, and trauma-informed routine healthcare for marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples during the current and future pandemics. More community-based research is needed to understand access needs for culturally safe routine healthcare amongst marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples.

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Social and Structural Barriers to Primary Care Access Among Women Living With HIV in Metro Vancouver, Canada: A Longitudinal Cohort Study

Cited by 6 publications

References 41 publications

Prevalence, correlates, and quality-of-life outcomes of major or persistent pain among women living with HIV in Metro Vancouver, Canada

Prevalence, correlates, and quality-of-life outcomes of major or persistent pain among women living with HIV in Metro Vancouver, Canada

Access to and quality of care for sexual and gender minority women living with HIV in Metro Vancouver, Canada: Results from a longitudinal cohort study

Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic

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