Positive Social and Socio-Economic Transitions Associated with Antiretroviral Therapy Exposure and Adherence Among HIV-Positive People Who Use Illicit Drugs in Vancouver, Canada

The clinical benefits of antiretroviral therapy (ART) for people living with HIV/AIDS (PLWH) are now unequivocal. However, the ability of some key affected populations of PLWH, such as people who use illicit drugs (PWUD), to enjoy these benefits, is inhibited by structural disadvantages that accompany stigmatization. These disadvantages include social and socio-economic marginalization that can inhibit optimal engagement and retention in HIV care. Conversely, the potential role of ART in mitigating stigma-driven structural disadvantage has not been sufficiently explored. These analyses therefore examined potential associations between ART exposure and optimal adherence and improved social and socio-economic outcomes. We supplemented longitudinal data from a prospective cohort of community-recruited HIV-positive PWUD in Vancouver, Canada, a setting of universal no-cost access to HIV care and medications, with comprehensive HIV clinical monitoring and ART dispensation records. We developed generalized linear mixed effects models examining whether (1) exposure to ART or (2) becoming adherent to ART was associated with positive social and socio-economic transitions, including relationship initiation, transitioning out of homelessness, entering employment and ceasing involvement in illegal or prohibited income generation activity. Between December 2005 and November 2013, 755 participants were eligible for analyses of ART exposure, and 724 participants were eligible for analyses of ART adherence. In final models, becoming exposed to ART was positively associated with transitioning out of homelessness and initiating a romantic relationship. Similarly, becoming adherent to ART was positively associated with ceasing prohibited or illegal income generation and transitioning out of homelessness, and marginally associated with initiating a romantic relationship. These findings point to the potentially important role of engagement and retention in HIV care for non-clinical domains in which improvements may mitigate the effects of stigmatization among PLWH who use illicit drugs. These findings reinforcing the importance of promoting access and adherence to ART for all PLWH.