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Employment predicts decreased mortality among HIV-seropositive illicit drug users in a setting of universal HIV care
  1. Lindsey A Richardson1,2,
  2. M-J S Milloy1,3,
  3. Thomas H Kerr1,2,
  4. Surita Parashar1,4,
  5. Julio S G Montaner1,2,
  6. Evan Wood1,2
  1. 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
  2. 2Faculty of Medicine (Division of AIDS), University of British Columbia, Vancouver, Canada
  3. 3Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
  4. 4Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
  1. Correspondence to Dr Evan Wood, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6; uhri-ew{at}cfenet.ubc.ca

Abstract

Objective Given the link between employment and mortality in the general population, we sought to assess this relationship among HIV-positive people who use illicit drugs in Vancouver, Canada.

Methods Data were derived from a prospective cohort study of HIV seropositive people who use illicit drugs (n=666) during the period of May 1996–June 2010 linked to comprehensive clinical data in Vancouver, Canada, a setting where HIV care is delivered without charge. We estimated the relationship between employment and mortality using proportional hazards survival analysis, adjusting for relevant behavioural, clinical, social and socioeconomic factors.

Results In a multivariate survival model, a time-updated measure of full time, temporary or self-employment compared with no employment was significantly associated with a lower risk of death (adjusted HR=0.44, 95% CI 0.22 to 0.91). Results were robust to adjustment for relevant confounders, including age, injection and non-injection drug use, plasma viral load and baseline CD4 T-cell count.

Conclusions These findings suggest that employment may be an important dimension of mortality risk of HIV-seropositive illicit drug users. The potentially health-promoting impacts of labour market involvement warrant further exploration given the widespread barriers to employment and persistently elevated levels of preventable mortality among this highly marginalised population.

  • AIDS
  • EMPLOYMENT
  • MORTALITY
  • SUBSTANCE ABUSE

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