Does resource insecurity drive HIV‐related stigma? Associations between food and housing insecurity with HIV‐related stigma in cohort of women living with HIV in Canada

Abstract

Introduction Women living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV‐related stigma—the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV—intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV‐related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV‐related stigma among women living with HIV in Canada. Methods This prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18‐month intervals between 2013 and 2018. To understand associations between food and housing security and HIV‐related stigma, we conducted linear mixed effects regression models. We adjusted for socio‐demographic characteristics associated with HIV‐related stigma. Results and discussion Among participants (n = 1422), more than one‐third (n = 509; 36%) reported baseline food insecurity and approximately one‐tenth (n = 152, 11%) housing insecurity. Mean HIV‐related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV‐related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV‐related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV‐related stigma at the third wave. Conclusions Among women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV‐related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV‐related stigma requires identifying and dismantling resource insecurity‐related stigma drivers.

Brief Report: Social Factors Associated With Trajectories of HIV-Related Stigma and Everyday Discrimination Among Women Living With HIV in Vancouver, Canada: Longitudinal Cohort Findings

“…Finally, our finding that sexual minority WLHIV reported higher trajectories of Everyday Discrimination builds on prior cross-sectional research that shows increased racial and gender discrimination, 9 and increased HIV-related stigma, 17 among sexual minority WLHIV compared with heterosexual counterparts. Heteronormativity, the assumption that all persons are or should be heterosexual, results in the experiences of sexual minority WLHIV being overlooked.…”

“…Our findings build on prior work that demonstrates that food and housing insecurity may result in higher HIV-related stigma exposure. 16,17 Findings extend beyond HIV-related stigma drivers to reveal that these resource insecurities are also associated with higher trajectories of Everyday Discrimination—itself a chronic stressor associated with a range of poorer health outcomes, 39,40 increased health care utilization, 39,40 and chronic disease. 40 Stigma and discrimination linked with food/housing insecurity reflect the ways in which poverty is stigmatized and perceived as “failure” and/or a disruption of public spaces.…”

“…For instance, among WLHIV in Canada, concurrent food and housing insecurity were linked with higher HIV-related stigma and racial discrimination in cross-sectional studies, 16 and food and housing insecurity were individually associated with higher HIV-related stigma trajectories. 17 Poverty stigma was linked with poorer HIV care outcomes among WLWHIV in the United States, 18 as was experiencing combinations of poverty, sex, and racial stigma. 19 In sum, these studies signal that HIV-related stigma drivers, and other forms of dayto-day mistreatment-referred to as "everyday" discrimination 20 -warrant further investigation among WLHIV who disproportionately experience poverty, [13][14][15] violence, 10,12 and discrimination based on race, [21][22][23] gender, 6,7 and sexual orientation, 9,24,25 among other socially devalued identities.…”

What will it take to get to the heart of stigma in the context of HIV?

“…For instance, Logie et al. [25] examined both food and housing insecurity as drivers of HIV‐related stigma, and present findings from a longitudinal engagement with a cohort of women living with HIV in Canada, finding resource scarcities linked with increased experiences of HIV‐related stigma.…”

Why we need to re‐define long‐term success for people living with HIV

“…Alongside these sources of stigma and discrimination, structural factors, including poverty and isolation, can further challenge the well-being of people living with HIV [12]. Circumstances of poverty, such as food insecurity and unstable housing, are highly prevalent among people living with HIV, particularly as they age [28][29][30]. Evidence suggests that the presence of poverty impedes even the most ambitious efforts to end the HIV epidemic [31].…”