Abstract
Objectives
Aboriginal Canadians (i.e., First Nations, Inuit and Métis) are disproportionately affected by HIV/AIDS, and experience greater social and economic marginalization and poorer housing conditions. This study sought to understand the differences in the determinants of health and housing-related characteristics between samples of Aboriginal and Caucasian adults living with HIV/AIDS in Ontario.
Methods
We analyzed baseline demographic, socio-economic, health, and housing-related data from 521 individuals (79 Aboriginal and 442 Caucasian) living with HIV/AIDS and enrolled in the Positive Spaces, Healthy Places study. We compared the characteristics of Aboriginal and Caucasian participants to identify determinants of health and housing-related characteristics independently associated with Aboriginal ethnicity.
Results
Compared to Caucausian participants living with HIV, Aboriginal participants were more likely to be younger, female or transgender women, less educated, unemployed, and homeless or unstably housed. They were also more likely to have low incomes and to have experienced housing-related discrimination. In a multivariate model, gender, income, and experiences of homelessness were independently associated with Aboriginal ethnicity.
Conclusion
Aboriginal individuals living with HIV/AIDS in our sample are coping with significantly worse social and economic conditions and are more likely to experience challenging housing situations than a comparison group of Caucasian individuals living with HIV/AIDS. To develop effective care, treatment and support strategies for Aboriginal peoples with HIV, it is critical to address and improve their socio-economic and housing conditions.
Mots clés: VIH, inégalité; déterminants de la santé, logement, population d’origine amérindienne
Key words: HIV, inequality, determinants of health, housing, Aboriginal peoples
Résumé
Objectifs
Les Canadiens autochtones (Premières Nations, Inuits et Métis) sont démesurément touchés par le VIH et le sida; ils sont aussi plus marginalisés sur le plan socioéconomique et ont des conditions de logement inférieures. Nous avons cherché à comprendre les différences dans les déterminants de la santé et les caractéristiques de l’habitat d’échantillons d’adultes autochtones et blancs vivant avec le VIH ou le sida en Ontario.
Méthode
Nous avons analysé les données de base (démographiques, socioéconomiques, sanitaires et liées au logement) de 521 sujets (79 Autochtones, 442 Blancs) vivant avec le VIH ou le sida et participant à l’étude Positive Spaces, Healthy Places. Les caractéristiques des participants autochtones et blancs ont été comparées afin de cerner les déterminants de la santé et les caractéristiques de l’habitat présentant une association indépendante avec l’ethnicité autochtone.
Résultats
Comparativement aux participants blancs vivant avec le VIH, les participants autochtones étaient plus susceptibles d’être des jeunes, des femmes ou des femmes transgenre, d’être moins scolarisés, sans emploi, sans abri ou de vivre dans un logement précaire. Ils étaient aussi plus susceptibles d’avoir un faible revenu et d’avoir été victimes de discrimination liée au logement. Dans notre modèle multivarié, le sexe, le revenu et les expériences d’itinérance présentaient des associations indépendantes avec l’ethnicité autochtone.
Conclusion
Les sujets autochtones vivant avec le VIH ou le sida dans notre échantillon composent avec des conditions socioéconomiques beaucoup plus difficiles et sont plus susceptibles d’éprouver des problèmes à se loger que le groupe témoin de sujets blancs vivant avec le VIH et le sida. Pour élaborer des stratégies de soins, de traitement et de soutien efficaces pour les Autochtones atteints du VIH, il est essentiel d’aborder et d’améliorer leurs conditions socioéconomiques et de logement.
Footnotes
Dedication: This article is dedicated to the memory of LaVerne Monette, co-investigator with the CIHR-funded Positive Spaces, Healthy Places (PSHP) research project, who passed away December 1, 2010. Responsible for the Aboriginal arm of the study, she played a key role in developing the questionnaire, analyzing the data and presenting the findings. She brought to our team her life experiences as an Aboriginal woman and her passion to help Aboriginal people living with and at risk of HIV. She understood the critical role of housing in health and quality of life, and was a strong advocate for research to identify the housing needs of Aboriginal people in Ontario and for policy change that will lead to safe, stable housing for all.
Acknowledgements: This work was supported by grants from the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long-Term Care, the Ontario AIDS Network, the Wellesley Institute, and the Ontario HIV Treatment Network.
Conflict of Interest: None to declare.
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