(O2) Employment of people living with HIV approaching that of the HIV-negative population irrespective of migrant status and sexual orientation
Christina Carlander (1,2), Philippe Wagner (2), Aylin Yilmaz (3), Pär Sparén (4), Veronica Svedhem (1)
1) Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden 2) Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås, Sweden 3) Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 4) Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Background: It is well established that unemployment is associated with an increased risk of morbidity, mortality and psychological distress. People living with HIV (PLWH) have been shown to have an increased risk of unemployment compared to the HIV-negative population. Unemployment has been suggested to be particularly high among women living with HIV and migrant PLWH born in sub-Saharan Africa yet there are few previous studies in this field including these populations. The aim of this study was to assess employment in the Swedish HIV cohort over twenty years compared to the HIV-negative population (HNP), controlled for region of birth.
Methods: From the Swedish Total Population Registry we identified all people born between 1940 and 2000, living in Sweden at some point between 1983 and 2017 (n=8 587 629) and linked them with the Swedish National HIV Registry (n=9 492) and the Longitudinal Integration Database for Health Insurance and Labor Market Studies. Prevalence ratios (PR) of employment were calculated using Poisson regression. Predictors of employment (age, sex, education, origin and civil status) were adjusted for (adjPR). For PLWH only we also adjusted for CD4 count, suppressive antiretroviral therapy (ART) (HIV-RNA <50 [<500 before 2004] copies/mL) and mode of HIV-transmission. Trends in employment were illustrated in scatterplots with overlaid prediction plots. In a subanalysis we included PLWH (n= 1691) who had answered a Health Questionnaire in 2016/2017.
Results: PLWH were less likely to be employed than HNP but with decreasing difference over time (adjPR 0.6, 95% CI 0.6-0.6 in 1996, adjPR 0.7, 95% CI 0.7-0.7 in 2006 and adjPR 0.9, 95% CI 0.9-0.9 in 2016) (Fig 1). Migrant women with HIV had the largest increase of employment (Fig 2) and the negative association between migrant status and employment decreased between 1996 (adjPR 0.7, 95% CI: 0.6-0.9) and 2016 (adjPR 0.9, 95% CI 0.9-1.0). The highest proportion of employment of PLWH was seen among Swedish-born men who have sex with men, while employment of PLWH with present/former intravenous drug use (IVDU) was persistently low (Fig 2). Suppressive ART associated with employment 2006 (adjPR 1.2, 95% CI 1.1-1.3) and 2016 (adjPR 1.3, 95% CI 1.2-1.4)) but not in 1996 (adjPR 1.1, 95% CI 0.9-1.2). Low CD4 count (<200) associated with reduced employment (adjPR 0.7, 95% CI 0.6-0.8). Self-reported satisfaction with psychological and physical health was associated with employment in 2016 (adjPR 1.4, 95% CI 1.2-1.6 and adjPR 1.3, 95% CI 1.1-1.5 respectively).
Conclusions: To our knowledge, this is the first study of employment of PLWH including a whole nation. Employment of PLWH increased over time, particularly in migrants, and was associated with suppressive ART, high CD4 count and self-reported satisfaction with psychological and physical health. People with former IVDU are an important target group for policies promoting employment.