Prevalence and determinants of unemployment among ageing HIV‐1‐infected and HIV‐uninfected individuals

Abstract

Purpose of the studyPeople living with HIV (PLWH) appear to be at increased risk for earlier onset of age‐associated non‐communicable co‐morbidity (AANCC) and declines in physical and mental capacities, compared to the general population [1]. This earlier onset of AANCC in the setting of HIV infection is likely to negatively affect work participation and quality of life. Present study investigates prevalence and determinants of unemployment among older HIV‐1‐infected and HIV‐uninfected participants of the AGEhIV Cohort Study.MethodsData were collected (Oct. 2010–Jan. 2012) within the ongoing prospective AGEhIV Cohort Study, recruiting HIV‐1‐infected patients >45 years from a tertiary care HIV outpatient clinic, and HIV‐uninfected Public Health Service attendants, comparable regarding age, gender and ethnicity. Data on socio‐demographics, lifestyle, quality of life, AANCC and unemployment were collected, using a self‐administered questionnaire and through medical examination. Current analysis was restricted to participants in the working age (45–65 years). Logistic regression analysis was used to study determinants of unemployment.Summary of resultsThe majority from the first enrolled 277 HIV‐1‐infected and 251 HIV‐uninfected subjects was male (88%), Dutch (76%) and homosexual (74%). About 50% was highly educated and the median age was 52 [IQR: 48–57]. Almost all (94%) HIV‐1‐infected individuals were on cART, median time since first ART was 11 years [IQR: 4–15], median time since HIV‐diagnosis was 12 years [IQR: 7–18] and they had been diagnosed with more AANCC than HIV‐uninfected individuals (p<0.01). Unemployment was higher among HIV‐1‐infected (36.5%) compared to HIV‐uninfected participants (21.9%) (p<0.01). In multivariate analysis, being HIV‐infected (ORadj 2.0 [95% CI: 1.3–3.3]), experiencing >2 AANCC (ORadj 3.1 [95% CI: 1.4–6.8]), lower physical health status (ORadj 2.0 [95% CI: 1.6–2.6]), being unmarried (ORadj 2.1 [95% CI: 1.3–3.2]) and older age (ORadj 60‐65 yrs: 9.1 [95% CI: 4.5–18]) were independently associated with higher levels of unemployment.ConclusionsUnemployment among HIV‐1‐infected individuals is higher compared to HIV‐uninfected individuals, independent of socio‐demographic characteristics, lifestyle, quality of life or number of concomitantly diagnosed AANCC. This suggests that, apart from these factors, specific HIV‐related determinants, such as stage of HIV disease, but also experienced stigma, work related conditions, influence unemployment.