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A Latent Class Analysis of the Social Determinants of Health Impacting Heavy Alcohol Consumption Among Women Living with HIV in Canada: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study

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Abstract

We used longitudinal data from the 2013–2017 Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (N = 1422) to assess the clustered impact of social determinants of health (SDoH) on hazardous drinking. Two measures of alcohol use were defined: (i) weekly alcohol use, with > 7 drinks/week as heavy drinking, and (ii) monthly binge drinking (≥ 6 drinks at one sitting), with ≥ 1/month as frequent binging. Twelve SDoH indicators were classified using latent class analysis: no/least adversities, discrimination/stigma, economic hardship, and most SDoH adversities. Inverse-probability weighted multinomial logistic regression was used to report relative-risk ratio (RRR). Women living with HIV (WLWH) in no/least adversity class had a substantially lower likelihood of both heavy weekly alcohol use and frequent binging than those in discrimination/stigma, economic hardship, and most SDoH adversities classes, with RRR estimates ranging from 0.02 to 0.18. Findings indicate the need to address SDoH to reduce hazardous drinking among WLWH.

Resumen

Utilizamos información del Estudio de Salud Sexual y Reproductiva de Mujeres viviendo con VIH en Canadá 2013-2017 (N = 1422) para evaluar el impacto agrupado de los determinantes sociales de la salud (DSS) sobre consumo riesgoso de alcohol. Se definieron dos medidas de consumo de alcohol: i) consumo abusivo de alcohol: uso de alcohol por semana, > de 7 bebidas/por semana y ii) consumo excesivo mensual (≥ 6 bebidas en una ocasión), con ≥ 1/mes como consumo excesivo frecuente. Utilizando el análisis de clases latentes se clasificaron doce indicadores de los DSS: no/menos adversidades, discriminación/estigma, dificultad económica, y la mayoría de las adversidades de los DSS. Para reportar el riesgo relativo (RR) se utilizó regresión logística multinomial ponderada de probabilidad-inversa. Mujeres viviendo con el VIH (MVCV) en la clase no/menos adversidad tuvieron menos probabilidad de ambos, consumo semanal abusivo de alcohol y de consumo excesivo frecuente, comparadas con aquellas en clases de discriminación/estigma, dificultad económica, y la mayoría de adversidades de los DSS, con estimaciones RR entre 0.02 a 0.18. Los hallazgos indican la necesidad de abordar los DSS para reducir el consumo riesgoso entre MVCV.

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Acknowledgements

We would like to thank the following groups for their significant contributions to the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), including women living with HIV who shared their experiences and provided valuable information on various aspects of their health, as well as Peer Research Associates (PRAs) for their engagement at every stage of this study and for recruiting participants, administering the survey and collecting data. We would also like to thank the members of the CHIWOS Research Team, the entire national team of Co-Investigators, Collaborators, the three provincial Community Advisory Boards, the national CHIWOS Indigenous Advisory Board, CHIWOS African, Caribbean and Black Advisory Board, and all partnering organisations for their supports. We thank the BC Centre for Excellence in HIV/AIDS for CHIWOS data management and support.

CHIWOS research team Rahma Abdul-Noor (Women’s College Research Institute), Aranka Anema (University of British Columbia), Jonathan Angel (Ottawa Hospital Research Institute), Jean-Guy Baril (Clinique du Quartier Latin), Fatimatou Barry (Women’s College Research Institute), Kerrigan Beaver (Women’s College Research Institute), Denise Becker (Positive Living Society of British Columbia), Anita Benoit (Women’s College Research Institute), Jason Brophy (Children’s Hospital of Eastern Ontario), Lori Brotto (University of British Columbia), Ann Burchell (Ontario HIV Treatment Network), Claudette Cardinal (Simon Fraser University), Allison Carlson (Women’s College Research Institute), Allison Carter (British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University), Angela Cescon (British Columbia Centre for Excellence in HIV/AIDS), Lynne Cioppa (Women’s College Research Institute), Jeffrey Cohen (Windsor Regional Hospital), Guillaume Colley (British Columbia Centre for Excellence in HIV/AIDS), Tracey Conway (Women’s College Research Institute), Curtis Cooper (Ottawa Hospital Research Institute), Jasmine Cotnam (Women’s College Research Institute), Janette Cousineau (Women’s College Research Institute), Janice Dayle (McGill University Health Centre), Marisol Desbiens (Women’s College Research Institute), Hania Dubinsky (McGill University Health Centre), Danièle Dubuc (McGill University Health Centre), Janice Duddy (Pacific AIDS Network), Brenda Gagnier (Women’s College Research Institute), Jacqueline Gahagan (Dalhousie University), Claudine Gasingirwa (Women’s College Research Institute), Nada Gataric (British Columbia Centre for Excellence in HIV/AIDS), Saara Greene (McMaster University), Trevor Hart (Ryerson University), Catherine Hankins (UNAIDS), Bob Hogg (British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University), Terry Howard (Positive Living Society of British Columbia), Shazia Islam (Women’s College Research Institute), Evin Jones (Pacific AIDS Network),Charu Kaushic (McMaster University), Alexandria Keating (ViVA and Southern Gulf Islands AIDS Society), Logan Kennedy (Women’s College Research Institute), Mary Kestler (Oak Tree Clinic, BC Women’s Hospital and Health Centre), Maxime Kiboyogo (McGill University Health Centre), Marina Klein (McGill University Health Centre), Gladys Kwaramba (Women’s College Research Institute), Andrea Langlois (Pacific AIDS Network), Melanie Lee (Simon Fraser University), Rebecca Lee (CIHR Canadian HIV Trials Network), Lynne Leonard (University of Ottawa), Johanna Lewis (Women’s College Research Institute),Viviane Lima (British Columbia Centre for Excellence in HIV/AIDS), Elisa Lloyd-Smith (Vancouver Coastal Health), Carmen Logie (University of Toronto), Shari Margolese (Women’s College Research Institute), Carrie Martin (Native Women`s Shelter of Montreal), Renee Masching (Canadian Aboriginal AIDS Network), Lyne Massie (Université du Québec à Montréal), Melissa Medjuck (Positive Women’s Network), Brigitte Ménard (McGill University Health Centre), Cari Miller (Simon Fraser University), Deborah Money (Women’s Health Research Institute), Marvelous Muchenje (Women’s Health in Women’s Hands), Mary Mwalwanda (Women’s College Research Institute), Mary (Muthoni) Ndung’u (Women’s College Research Institute), Valerie Nicholson (Simon Fraser University), Illuminée Nzikwikiza (McGill University Health Centre), Kelly O’Brien (University of Toronto), Nadia O’Brien (McGill University Health Centre and McGill University), Gina Ogilvie (British Columbia Centre for Disease Control), Susanna Ogunnaike-Cooke (Public Health Agency of Canada), Joanne Otis (Université du Québec à Montréal), Ali Palmer (Simon Fraser University), Sophie Patterson (Simon Fraser University), Doris Peltier (Canadian Aboriginal AIDS Network), Yasmeen (Ashria) Persad (Women’s College Research Institute), Neora Pick (Oak Tree Clinic, BC Women’s Hospital and Health Centre), Alie Pierre, McGill University Health Centre), Jeff Powis (Toronto East General Hospital), Karène Proulx-Boucher (McGill University Health Centre), Corinna Quan (Windsor Regional Hospital), Janet Raboud (Ontario HIV Treatment Network), Anita Rachlis (Sunnybrook Health Science Centre), Edward Ralph (St. Joseph’s Health Care), Stephanie Rawson (Simon Fraser University, BC), Eric Roth (University of Victoria), Danielle Rouleau (Centre Hospitalier de l’Université de Montréal), Sean Rourke (Ontario HIV Treatment Network), Sergio Rueda (Centre for Addiction and Metal Health), Mercy Saavedra (Women’s College Research Institute), Kate Salters (Simon Fraser University), Margarite Sanchez (ViVA and Southern Gulf Islands AIDS Society), Roger Sandre (Haven Clinic), Jacquie Sas (CIHR Canadian HIV Trials Network), Paul Sereda (British Columbia Centre for Excellence in HIV/AIDS), Fiona Smaill (McMaster University), Stephanie Smith (Women’s College Research Institute), Marcie Summers (Positive Women’s Network), Tsitsi Tigere (Women’s College Research Institute), Wangari Tharao (Women’s Health in Women’s Hands), Jamie Thomas-Pavanel (Women’s College Research Institute), Christina Tom (Simon Fraser University, BC), Cécile Tremblay (Centre Hospitalier de l’Université de Montréal), Benoit Trottier (Clinique l’Actuel), Sylvie Trottier (Centre Hospitalier Universitaire de Québec), Christos Tsoukas (McGill University Health Centre), Anne Wagner (Ryerson University), Sharon Walmsley (Toronto General Research Institute), Kath Webster (Simon Fraser University), Wendy Wobeser (Kingston University), Jessica Yee (Native Youth Sexual Health Network), Mark Yudin (St-Michael’s Hospital), Wendy Zhang (British Columbia Centre for Excellence in HIV/AIDS). All other CHIWOS Research Team Members who wish to remain anonymous.

Funding

CHIWOS is supported by funding from the Canadian Institutes of Health Research (CIHR) (Grant No: MOP-111041; FDN154325), the CIHR Canadian HIV Trials Network (CTN 262), the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund, the Ontario HIV Treatment Network, and the Institute of Gender, Sex, and Health. Ontario Trillium Scholarship supports the first author (MS). AK is supported by a Canada Research Chair (Tier 2).

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Authors and Affiliations

  1. Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada

    Mostafa Shokoohi & Greta R. Bauer

  2. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    Angela Kaida & Allison Carter

  3. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada

    Carmen H. Logie

  4. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Carmen H. Logie & Mona Loutfy

  5. Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada

    Allison Carter

  6. The Kirby Institute, University of New South Wales, Sydney, Australia

    Allison Carter

  7. School of Social Work, University of Michigan, Ann Arbor, MI, USA

    Ashley Lacombe-Duncan

  8. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Mona Loutfy

  9. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Mona Loutfy

Authors
  1. Mostafa Shokoohi
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  2. Greta R. Bauer
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  3. Angela Kaida
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  4. Carmen H. Logie
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  5. Allison Carter
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  6. Ashley Lacombe-Duncan
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  7. Mona Loutfy
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Consortia

the CHIWOS Research Team

  • Rahma Abdul-Noor
  • , Aranka Anema
  • , Jonathan Angel
  • , Jean-Guy Baril
  • , Fatimatou Barry
  • , Kerrigan Beaver
  • , Denise Becker
  • , Anita Benoit
  • , Jason Brophy
  • , Lori Brotto
  • , Ann Burchell
  • , Claudette Cardinal
  • , Allison Carlson
  • , Allison Carter
  • , Angela Cescon
  • , Lynne Cioppa
  • , Jeffrey Cohen
  • , Guillaume Colley
  • , Tracey Conway
  • , Curtis Cooper
  • , Jasmine Cotnam
  • , Janette Cousineau
  • , Janice Dayle
  • , Marisol Desbiens
  • , Hania Dubinsky
  • , Danièle Dubuc
  • , Janice Duddy
  • , Brenda Gagnier
  • , Jacqueline Gahagan
  • , Claudine Gasingirwa
  • , Nada Gataric
  • , Saara Greene
  • , Trevor Hart
  • , Catherine Hankins
  • , Bob Hogg
  • , Terry Howard
  • , Shazia Islam
  • , Evin Jones
  • , Charu Kaushic
  • , Alexandria Keating
  • , Logan Kennedy
  • , Mary Kestler
  • , Maxime Kiboyogo
  • , Marina Klein
  • , Gladys Kwaramba
  • , Andrea Langlois
  • , Melanie Lee
  • , Rebecca Lee
  • , Lynne Leonard
  • , Johanna Lewis
  • , Viviane Lima
  • , Elisa Lloyd-Smith
  • , Carmen Logie
  • , Shari Margolese
  • , Carrie Martin
  • , Renee Masching
  • , Lyne Massie
  • , Melissa Medjuck
  • , Brigitte Ménard
  • , Cari Miller
  • , Deborah Money
  • , Marvelous Muchenje
  • , Mary Mwalwanda
  • , Mary Ndung’u
  • , Valerie Nicholson
  • , Illuminée Nzikwikiza
  • , Kelly O’Brien
  • , Nadia O’Brien
  • , Gina Ogilvie
  • , Susanna Ogunnaike-Cooke
  • , Joanne Otis
  • , Ali Palmer
  • , Sophie Patterson
  • , Doris Peltier
  • , Yasmeen Persad
  • , Neora Pick
  • , Alie Pierre
  • , Jeff Powis
  • , Karène Proulx-Boucher
  • , Corinna Quan
  • , Janet Raboud
  • , Anita Rachlis
  • , Edward Ralph
  • , Stephanie Rawson
  • , Eric Roth
  • , Danielle Rouleau
  • , Sean Rourke
  • , Sergio Rueda
  • , Mercy Saavedra
  • , Kate Salters
  • , Margarite Sanchez
  • , Roger Sandre
  • , Jacquie Sas
  • , Paul Sereda
  • , Fiona Smaill
  • , Stephanie Smith
  • , Marcie Summers
  • , Tsitsi Tigere
  • , Wangari Tharao
  • , Jamie Thomas-Pavanel
  • , Christina Tom
  • , Cécile Tremblay
  • , Benoit Trottier
  • , Sylvie Trottier
  • , Christos Tsoukas
  • , Anne Wagner
  • , Sharon Walmsley
  • , Kath Webster
  • , Wendy Wobeser
  • , Jessica Yee
  • , Mark Yudin
  •  & Wendy Zhang

Corresponding author

Correspondence to Mostafa Shokoohi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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The CHIWOS Research Team is detailed in the Acknowledgment section.

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Shokoohi, M., Bauer, G.R., Kaida, A. et al. A Latent Class Analysis of the Social Determinants of Health Impacting Heavy Alcohol Consumption Among Women Living with HIV in Canada: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study. AIDS Behav 23, 3226–3236 (2019). https://doi.org/10.1007/s10461-019-02454-3

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