title: Employment predicts decreased mortality among HIV-seropositive illicit drug users in a setting of universal HIV care.
abstract: OBJECTIVE
  Given the link between employment and mortality in the general population, we sought to assess this relationship among HIV-positive people who use illicit drugs in Vancouver, Canada.
  
  
  METHODS
  Data were derived from a prospective cohort study of HIV seropositive people who use illicit drugs (n=666) during the period of May 1996-June 2010 linked to comprehensive clinical data in Vancouver, Canada, a setting where HIV care is delivered without charge. We estimated the relationship between employment and mortality using proportional hazards survival analysis, adjusting for relevant behavioural, clinical, social and socioeconomic factors.
  
  
  RESULTS
  In a multivariate survival model, a time-updated measure of full time, temporary or self-employment compared with no employment was significantly associated with a lower risk of death (adjusted HR=0.44, 95% CI 0.22 to 0.91). Results were robust to adjustment for relevant confounders, including age, injection and non-injection drug use, plasma viral load and baseline CD4 T-cell count.
  
  
  CONCLUSIONS
  These findings suggest that employment may be an important dimension of mortality risk of HIV-seropositive illicit drug users. The potentially health-promoting impacts of labour market involvement warrant further exploration given the widespread barriers to employment and persistently elevated levels of preventable mortality among this highly marginalised population.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, , Vancouver, Canada.
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Richardson
authors.forename: M-J S
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Kerr
authors.forename: Surita
authors.initials: S
authors.lastname: Parashar
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D001955:British Columbia / Q000453:epidemiology; D015897:Comorbidity; D055030:Drug Users / Q000706:statistics & numerical data*; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000401:mortality* / Q000523:psychology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D019472:Universal Health Insurance; D055815:Young Adult
keywords: AIDS; EMPLOYMENT; MORTALITY; SUBSTANCE ABUSE