Advancing our understanding of employment as a social determinant of health among people with HIV in Ontario, Canada

Aim: Increased longevity as a result of advancements in HIV treatments has made it possible for people living with HIV to pursue or maintain their desired work. However, many of these individuals continue to be impacted by labor market discrimination (e.g., unemployment, job insecurity) as well as other social determinants of health (e.g., poverty, race, social exclusion). There is still a pressing need to examine the impact of labor market experiences on HIV health and prevention outcomes (e.g., health-related quality of life (QoL) and health-risk behaviors). Subject and methods: Grounded in the client-focused considering work model, this study presents a longitudinal prospective data analysis of the Ontario HIV Treatment Network Cohort study from 2008 to 2017 with 2028 participants living with HIV. Results: Employment was a strong predictor of both physical and mental health-related QoL, but more strongly related to the former. We also found that the health-related QoL was influenced by specific psychosocial (education, race, country of birth, age), medical (depressive symptoms, smoking, and alcohol use), financial (income), and employment factors. Conclusion: The contribution of employment independently and in combination with income to both physical and mental health-related QoL signifies its importance as a social determinant of health. However, the temporal relationship between employment and health and vice versa is still contested. Robust systems for addressing the employment needs of people living with HIV are recommended.