Day-to-day experiences of racism influence women’s access to HIV care, study

published on June 19, 2018

(VANCOUVER, June 19, 2018) Women living with HIV who experience higher levels of racism are less likely to be engaged in HIV care, according to research from the BC Centre for Excellence in HIV/AIDS (BC-CfE), BC Women's Hospital and Simon Fraser University (SFU) published today in the Journal of Acquired Immune Deficiency Syndromes (JAIDS). This finding is based on analysis of a cohort of over 1,400 women living with HIV in British Columbia, Ontario and Quebec enrolled in CHIWOS, Canada's largest ongoing community-based study.

Previous BC-CfE research shows that women living with HIV tend to generally have more drop-off along every step in the cascade of care compared with men living with HIV. On sustained antiretroviral treatment, an individual living with HIV can achieve viral suppression and an undetectable HIV viral load, which improves health and effectively eliminates the risk of transmitting HIV to an HIV-negative sexual partner. This is the final step along the cascade of care, which begins with an HIV diagnosis followed by engagement in care and treatment.

"Experiences of racial discrimination account for a very significant loss from HIV care, but we observed no such relationship when we looked at racial identity," said Dr. Angela Kaida, an Associate Researcher with the BC-CfE, Associate Professor at SFU and senior author on the study. "These findings reveal that it is not that Indigenous women, for example, are somehow 'at risk' of attrition because they are Indigenous. Rather, the environments within which they live, interact with daily and seek care shape their engagement in the HIV care cascade."

"This study clearly shows a need to achieve more inclusive care for individuals who may feel culturally or otherwise excluded from existing care systems. Accounting for a historical system of colonialization is also critical to effectively include all individuals in consistent HIV treatment and care," said Valerie Nicholson, an Elder, Indigenous woman living with HIV and CHIWOS Study team member.

Those who identified as Indigenous reported the highest levels racial of discrimination in their day-to-day experiences, measured on a six-point scale by asking women how often racist events occurred because of their race (e.g., "you are treated with less courtesy," "you receive poorer service"). According to the scores by racial identity among the CHIWOS cohort (not included in the study report), women who identified as Indigenous experienced the most racist events, followed by those who identified as African, Caribbean or Black Canadian (ACB), and then those who identified as "other or multiple ethnicities".

Notably, women in the CHIWOS study who identified as ACB had the highest rates of virologic suppression; 84% of ACB women were suppressed compared to 57% of Indigenous women. This is in contrast to the United States, where there are far lower rates of virologic suppression among Black American women (with estimates ranging from 49 to 73%). "There is no shortage of evidence that the stress associated with racism has negative health outcomes, regardless of socioeconomic status. Our study shows Indigenous Canadian women are least likely to remain engaged in HIV care and, unsurprisingly, continue to suffer from centuries of systematic, institutional racism in their own country. We see similar patterns for non-immigrant Black American women in the United States," said Mary Kestler, Clinical Assistant Professor of Medicine at the University of British Columbia and Infectious Disease Specialist with the Oak Tree Clinic and St. Paul's Hospital.

The largest attrition rates occurred between current use of HIV antiretrovirals and adherence to a consistent treatment, with the greatest losses occurring among: Indigenous women, younger women aged 16-29, women with current injection drug use and women incarcerated in the past year. Women incarcerated within the last year had a three-fold higher odd of non-adherence to their HIV treatment and were 3.6 times less likely to achieve viral suppression. Other factors associated with attrition in the study included binge alcohol use, unstable housing, low annual household income and food insecurity.

While the study highlighted drop-offs and gaps in care, the CHIWOS cohort overall are near to reaching some of the 90-90-90 targets designated by the United Nations and UNAIDS: Ninety-seven per cent was retained in care and 87% was virally suppressed. If 90% of people living with HIV are diagnosed, 90% of those diagnosed receive treatment and 90% of those achieve an undetectable viral load, the end of AIDS could be reached by 2030.

About the British Columbia Centre for Excellence in HIV/AIDS – cfenet.ubc.ca
The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada's largest HIV/AIDS research, treatment and education facility – nationally and internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. The made-in-BC Treatment as Prevention® strategy (TasP®), pioneered by BC-CfE and supported by UNAIDS since 2011, inspired the ambitious global 90-90-90 target to end AIDS as a pandemic by 2030. The BC-CfE is applying TasP® to therapeutic areas beyond HIV/AIDS, including viral hepatitis and substance use, to promote Targeted Disease Elimination as a means to contribute to health care sustainability. The BC-CfE works in close collaboration with key stakeholders, including government, health authorities, health care providers, academics, and the community to decrease the health burden of HIV/AIDS, HCV and substance use across Canada and around the world.

About the CHIWOS Study - www.chiwos.ca
Supported by the BC-CfE, CHIWOS (Canadian HIV Women's Sexual and Reproductive Health) is Canada's largest ongoing community-based study with over 1,400 women living with HIV enrolled from British Columbia, Ontario and Quebec.

For more information, please contact:
Caroline Dobuzinskis, BC-CfE Communications Coordinator
Phone: 604-366-6540
Email: cdobuzin@cfenet.ubc.ca

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Day-to-day experiences of racism influence women’s access to HIV care, study

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