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PLoS One. 2019 Mar 21;14(3):e0213901. doi: 10.1371/journal.pone.0213901. eCollection 2019.

Social determinants of health and self-rated health status: A comparison between women with HIV and women without HIV from the general population in Canada.

Author information

Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada.
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
School of Social Work, University of Michigan, Ann Arbor, MI, United States of America.
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
McGill University Health Centre, Montreal, Quebec, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.



Women living with HIV (WLWH) continue to experience poorer outcomes across the HIV care cascade and overall health, an appreciable proportion of which may not be disease-related but due to socio-structural barriers that impact health. We compared socio-structural determinants of health and self-rated health between WLWH and expected general population values.


Prevalences of socio-structural determinants and self-rated health were estimated from 1,422 WLWH aged 16+ in the 2013-2015 Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Prevalences were also estimated from 46,831 general population women (assumed HIV-negative) in the 2013-2014 Canadian Community Health Survey (CCHS), standardized to the age/ethnoracial group distribution of WLWH. Standardized prevalence differences (SPDs) and 95% confidence intervals (CI) were reported.


Compared to general population women, a higher proportion of WLWH reported annual personal income <$20,000 (SPD 42.2%; 95% CI: 39.1, 45.2), indicating that 42.2% of WLWH experienced this low income, in excess of what would be expected of Canadian women of similar ages/ethnoracial backgrounds. A higher proportion of WLWH reported severe food insecurity (SPD 43.9%; 40.2, 47.5), poor perceived social support (SPD 27.4%; 22.2, 33.0), frequent racial (SPD 36.8%; 31.9, 41.8) and gender (SPD 46.0%; 42.6, 51.6) discrimination, and poor/fair self-rated health (SPD 12.2%; 9.4, 15.0).


Significant socio-structural inequalities and lower self-rated health were found among WLWH compared to general population women. Such inequities support the integration of a social-determinants approach, social service delivery, and programming into HIV care, with additional resource allocation tailored to the particular needs of WLWH.

Conflict of interest statement

The authors have declared that no competing interests exist.

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