Sex differences in houselessness, injection drug use, and mental health conditions among people newly diagnosed with HIV in Manitoba, Canada from 2018 to 2021: a retrospective cohort study.

Autor:	Sharp A; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada., Sorokopud-Jones M; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada., Haworth-Brockman M; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.; National Collaborating Centre for Infectious Diseases, Winnipeg, Canada., Kasper K; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.; Manitoba HIV Program, Winnipeg, Canada.; Health Science Centre Winnipeg, Shared Health, Winnipeg, Canada., MacKenzie L; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.; Manitoba HIV Program, Winnipeg, Canada., Ireland L; Manitoba HIV Program, Winnipeg, Canada.; Nine Circles Community Health Centre, Winnipeg, Canada.; Department of Family Medicine, University of Manitoba Rady Faculty of Health Sciences, Winnipeg, MB, R3E 0J9, Canada., Gawlik K; Health Science Centre Winnipeg, Shared Health, Winnipeg, Canada., Lopez L; Public Health Research Group, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia., Vanegas JM; Public Health Research Group, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia., Bullard J; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.; Section of Pediatric Infectious Diseases, Department of Pediatrics and Child Health, Winnipeg, Canada.; Cadham Provincial Laboratory, Winnipeg, Canada., Boodman C; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada., Sanguins J; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada., Payne M; Manitoba HIV Program, Winnipeg, Canada.; Nine Circles Community Health Centre, Winnipeg, Canada., Templeton K; Manitoba HIV Program, Winnipeg, Canada., Keynan Y; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.; National Collaborating Centre for Infectious Diseases, Winnipeg, Canada., Rueda ZV; Public Health Research Group, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia.
Jazyk:	angličtina
Zdroj:	Lancet regional health. Americas [Lancet Reg Health Am] 2024 Jun 06; Vol. 36, pp. 100805. Date of Electronic Publication: 2024 Jun 06 (Print Publication: 2024).
DOI:	10.1016/j.lana.2024.100805
Abstrakt:	Background: Manitoba saw the highest number of new HIV diagnoses in the province's history in 2021 and is the only Canadian province not meeting any of the previous UNAIDS 90-90-90 targets. Our goal was to describe sex differences and syndemic conditions within an incident HIV cohort in Manitoba, and the HIV treatment initiation and undetectable viral load outcomes. Methods: This was a retrospective cohort study of all people 18 years and older newly diagnosed with HIV in Manitoba, Canada between January 1st, 2018 and December 31st, 2021. Data was collected as follows: before HIV diagnosis : chlamydia, gonorrhoea, syphilis, and/or hepatitis C antibodies. At the time of HIV diagnosis : age, sex, gender, race/ethnicity, sexual orientation. During follow-up : CD4 counts, viral load, HIV treatment, hospitalizations, and number of visits to HIV care. Main exposures evaluated: methamphetamine use, injection drug use, houselessness, and mental health conditions. Outcomes: started antiretroviral treatment and achieved an undetectable viral load. A descriptive statistical analysis was used. Findings: There were 404 new HIV diagnoses in Manitoba from 2018 to 2021; 44.8% were female, 55.2% male; 76.% self-identified as Indigenous, 13.4% white/European, 4.7% African/black; 86.6% cis-gender; 60.9% heterosexual, 13.4% gay, bisexual and men who have sex with men, and 1.7% lesbian. Injection drug use was reported by 71.8% and 43.5% of females and males respectively. Methamphetamine was the most frequently injected drug (62.4%). Amongst females, 81.8% experienced at least one of the following: houselessness (43.1%), mental health comorbidities (46.4%), and injection drug use (71.8%). Only 64.9% of all individuals had an undetectable viral load (61.1% females and 67.9% males), 56.5% among people experiencing houselessness, 59% among young people (≤29 years), and 60.1% among people who inject drugs. Interpretation: People newly diagnosed with HIV in Manitoba are disproportionately experiencing houselessness, mental illness, and injection drug use (mostly methamphetamine). This pattern is more pronounced for female individuals. These findings highlight the need for syndemic and gender-specific approaches, simultaneously addressing social and health conditions, to treat HIV. Funding: This work was supported by the Canadian Institutes of Health Research, The Manitoba Medical Service Foundation, The James Farley Memorial Fund and the Canada Research Chairs Program. Competing Interests: MHB declares work as a consultant for the Assembly of First Nations and the Canadian Institute for the Advancement of Women. There are no competing interests to report. (© 2024 The Author(s).)
Databáze:	MEDLINE
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