Scientific Publications Database
Article Title: Exploring social ecological pathways from resilience to quality of life among women living with HIV in CanadaAuthors: Logie, Carmen H.; Wang, Ying; Kazemi, Mina; Hawa, Roula; Kaida, Angela; Conway, Tracey; Webster, Kath; de Pokomandy, Alexandra; Loutfy, Mona; Abdul-Noor, Rahma; Anema, Aranka; Angel, Jonathan; Baril, Jean-Guy; Barry, Fatimatou; Bauer, Greta; Beaver, Kerrigan; Becker, Denise; Benoit, Anita; Brophy, Jason; Brotto, Lori; Burchell, Ann; Cardinal, Claudette; Carlson, Allison; Carter, Allison; Cescon, Angela; Cioppa, Lynne; Cohen, Jeffrey; Colley, Guillaume; Conway, Tracey; Cooper, Curtis; Cotnam, Jasmine; Cousineau, Janette; Dayle, Janice; Desbiens, Marisol; Dubinsky, Hania; Dubuc, Daniele; Duddy, Janice; Gagnier, Brenda; Gahagan, Jacqueline; Gasingirwa, Claudine; Gataric, Nada; Greene, Saara; Hart, Trevor; Hankins, Catherine; Hogg, Bob; Howard, Terry; Islam, Shazia; Jones, Evin; Kaushic, Charu; Keating, Alexandria; Kennedy, Logan; Kestler, Mary; Kiboyogo, Maxime; Klein, Marina; Kwaramba, Gladys; Langlois, Andrea; Lee, Melanie; Lee, Rebecca; Leonard, Lynne; Lewis, Johanna; Lima, Viviane; Lloyd-Smith, Elisa; Logie, Carmen; Margolese, Shari; Martin, Carrie; Masching, Renee; Massie, Lyne; Medjuck, Melissa; Menard, Brigitte; Miller, Cari; Money, Deborah; Muchenje, Marvelous; Mwalwanda, Mary; Ndungu, Mary (Muthoni); Nicholson, Valerie; Nzikwikiza, Illuminee; O'Brien, Kelly; O'Brien, Nadia; Ogilvie, Gina; Ogunnaike-Cooke, Susanna; Otis, Joanne; Palmer, Ali; Patterson, Sophie; Peltier, Doris; Persad, Yasmeen (Ashria); Pick, Neora; Pierre, Alie; Powis, Jeff; Proulx-Boucher, Karene; Quan, Corinna; Raboud, Janet; Rachlis, Anita; Ralph, Edward; Rawson, Stephanie; Roth, Eric; Rouleau, Danielle; Rourke, Sean; Rueda, Sergio; Saavedra, Mercy; Salters, Kate; Sanchez, Margarite; Sandre, Roger; Sas, Jacquie; Sereda, Paul; Smaill, Fiona; Smith, Stephanie; Summers, Marcie; Tigere, Tsitsi; Tharao, Wangari; Thomas-Pavanel, Jamie; Tom, Christina; Tremblay, Cecile; Trottier, Benoit; Trottier, Sylvie; Tsoukas, Christos; Wagner, Anne; Walmsley, Sharon; Webster, Kath; Wobeser, Wendy; Yee, Jessica; Yudin, Mark; Zhang, Wendy
Journal: AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV Volume 30
Date of Publication:2018
Abstract:
Resilience, positive growth in contexts of stress and adversity, is shaped by social ecological factors. Among people living with HIV, resilience is associated with myriad positive health benefits and improved health-related quality of life (HR-QoL). Identifying contextual factors associated with resilience among women living with HIV (WLWH) is particularly important as this population experiences many stressors and inequalities. We examined social-ecological factors associated with resilience and its relationship with HR-QoL among WLWH. We utilized baseline survey data from a national cohort of WLWH (n=1424) in Canada. We conducted structural equation modelling using maximum likelihood estimation methods to test the direct effects of social support and women-centred HIV care (WCHC) on resilience, and the direct effects of resilience on mental and physical HR-QoL. We also tested the indirect effects of resilience on HR-QoL via HIV disclosure concerns and economic insecurity. Participant median age was 43 years (IQR=35-50); most participants were women of colour (29% Black; 22% Indigenous; 7% other ethnicities; 41% Caucasian). Social support and WCHC were associated with increased resilience. The direct path from resilience to mental HR-QoL was significant, accounting for the mediation effects of economic insecurity and social support. The direct path from resilience to physical HR-QoL was significant, accounting for the mediation effects of economic insecurity. Economic insecurity partially mediated the relationship between resilience and mental HR-QoL and physical HR-QoL. HIV disclosure concerns partially mediated the relationship between resilience and mental-HR-QoL. Model fit indices suggested that the model fit the data well (2[14]=160.378, P<0.001; CFI=0.987; RMSE=0.048 [90% CI:0.042-0.080]; SRMR=0.036). Findings suggest social (social support) and structural (WCHC) factors increase resilience. While resilience is associated with improved HR-QoL, social (HIV disclosure concerns) and structural (economic insecurity) factors partially mediate these associations and threaten HR-QoL. Multi-level interventions can address social ecological contexts to advance resilience and HR-QoL among WLWH.