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High perceived social standing is associated with better health in HIV-infected Ugandan adults on highly active antiretroviral therapy

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Abstract

Perceived social standing (PSS) was evaluated as a determinant of differences in health outcomes among Ugandan HIV-infected adults from Kampala using cross-sectional study design. PSS was defined using the MacArthur scale of subjective social status translated and adapted for the study setting. Socio-demographic and psychosocial correlates of PSS ranking at enrollment were determined using linear regression models. High versus low PSS was defined based on the median PSS score and evaluated as a determinant of body mass index, hemoglobin, quality of life (QOL) and frailty-related phenotype via linear regression. A log-binomial regression model estimated the relative-risk of good, very good or excellent versus fair or poor self-rated health (SRH) in relation to PSS. Older age, increasing social support and material wealth were correlated with high PSS ranking, whereas female sex, experience of multiple stigmas and multiple depressive symptoms were correlated with low PSS ranking. High PSS participants were on average 1.1 kg/m2 heavier, had 4.7 % lower frailty scores and 3.6 % higher QOL scores compared to low PSS patients (all p < 0.05); they were also more likely to self-classify as high SRH (RR 1.4, 95 % confidence interval 1.1, 1.7) but had comparable hemoglobin levels (p = 0.634). Low PSS correlated with poor physical and psychosocial wellbeing in HIV-positive Ugandan adults. The assessment of PSS as part of clinical management, combined with efforts to reduce stigma and improve social support, may identify and possibly reduce PSS-associated health inequality in Ugandan adults with HIV.

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Acknowledgments

Research reported in this publication was supported by the Eunice Kennedy Shriver National. Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD060333. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author contributions

A.E., D.G., Y.C.M. and W.W.F. contributed to study design, data interpretation, drafting and revising of the manuscript for important intellectual content. A.E. conceived of the study question, led analysis, data interpretation manuscript development. H.W., K.B. and E.S. contributed to data analysis and drafting of the manuscript including its revision for important intellectual content. M.W., D.B. and R.K. contributed to analysis, study design, interpretation of data, and revised the paper critically for important intellectual content. All authors were involved in the final approval of the version to be published.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, The University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA, 30602, USA

    A. E. Ezeamama & K. Brown

  2. School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda

    D. Guwatudde, D. Bagenda & H. Wamani

  3. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda

    R. Kyeyune & Y. C. Manabe

  4. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    M. Wang & W. W. Fawzi

  5. Division of Infectious Diseases, Department of Medicine, John Hopkins University, Baltimore, MD, USA

    Y. C. Manabe

  6. Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA

    D. Bagenda, Emily Smith & W. W. Fawzi

  7. Department of Nutrition, Harvard School of Public Health, Boston, MA, 02115, USA

    W. W. Fawzi

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  1. A. E. Ezeamama
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  2. D. Guwatudde
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  3. M. Wang
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  4. D. Bagenda
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  6. R. Kyeyune
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  7. Emily Smith
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  8. H. Wamani
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  9. Y. C. Manabe
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  10. W. W. Fawzi
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Correspondence to A. E. Ezeamama.

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A. E. Ezeamama, D. Guwatudde, M. Wang, D. Bagenda, K. Brown, R. Kyeyune, Emily Smith, H. Wamani, Y. C. Manabe, and W. W. Fawzi declare that they have no conflict of interest.

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All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Ezeamama, A.E., Guwatudde, D., Wang, M. et al. High perceived social standing is associated with better health in HIV-infected Ugandan adults on highly active antiretroviral therapy. J Behav Med 39, 453–464 (2016). https://doi.org/10.1007/s10865-015-9710-x

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