title: Influence of employment and job security on physical and mental health in adults living with HIV: cross-sectional analysis.
abstract: BACKGROUND
  In the general population, job insecurity may be as harmful to health as unemployment. Some evidence suggests that employment is associated with better health outcomes among people with HIV, but it is not known whether job security offers additional quality-of-life benefits beyond the benefits of employment alone.
  
  
  METHODS
  We used baseline data for 1660 men and 270 women who participated in the Ontario HIV Treatment Network Cohort Study, an ongoing observational cohort study that collects clinical and socio-behavioural data from people with HIV in the province of Ontario, Canada. We performed multivariable regression analyses to determine the contribution of employment and job security to health-related quality of life after controlling for potential confounders.
  
  
  RESULTS
  Employed men with secure jobs reported significantly higher mental health-related quality of life than those who were non-employed (β = 5.27, 95% confidence interval [CI] 4.07 to 6.48), but insecure employment was not associated with higher mental health scores relative to non-employment (β = 0.18, 95% CI -1.53 to 1.90). Thus, job security was associated with a 5.09-point increase on a 100-point mental health quality-of-life score (95% CI 3.32 to 6.86). Among women, being employed was significantly associated with both physical and mental health quality of life, but job security was not associated with additional health benefits.
  
  
  CONCLUSIONS
  Participation in employment was associated with better quality of life for both men and women with HIV. Among men, job security was associated with better mental health, which suggests that employment may offer a mental health benefit only if the job is perceived to be secure. Employment policies that promote job security may offer not only income stability but also mental health benefits, although this additional benefit was observed only for men.
authors.affiliation: Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto ON M4T 1X3, Canada. srueda@ohtn.on.ca
authors.forename: Sergio
authors.initials: S
authors.lastname: Rueda
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.forename: Sean B
authors.initials: SB
authors.lastname: Rourke
authors.forename: Tsegaye
authors.initials: T
authors.lastname: Bekele
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bayoumi
authors.forename: John
authors.initials: J
authors.lastname: Lavis
authors.forename: John
authors.initials: J
authors.lastname: Cairney
authors.forename: Cameron
authors.initials: C
authors.lastname: Mustard
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003710:Demography; D004651:Employment / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011640:Public Policy; D011788:Quality of Life; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors