title: Food insufficiency, housing and health-related quality of life: results from the Positive Spaces, Healthy Places study.
abstract: Studies of people living with HIV who are homeless or unstably housed show a high prevalence of food insufficiency (>50%) and associated poor health outcomes; however, most evidence is in the form of cross-sectional studies. To better understand this issue, we conducted a longitudinal study to examine the impact of food insufficiency and housing instability on overall physical and mental health-related quality of life (HRQoL) among people living with HIV in Ontario. Six hundred and two adults living with HIV were enrolled in the Positive Spaces, Healthy Places study and followed from 2006 to 2009. Interviewer-administered questionnaires were used, and generalized linear mixed-effects models constructed to examine longitudinal associations between food insufficiency, housing instability and physical and mental HRQoL. At baseline, 57% of participants were classified as food insufficient. After adjusting for potential confounders, longitudinal analyses revealed a significant, negative association between food insufficiency and physical and mental HRQoL outcomes, respectively [effect size (ES) with 95% confidence interval (CI): (ES = -2.1, CI = -3.9,-0.3); (ES = -3.5, CI = -6.1,-1.5)]. Furthermore, difficulties meeting housing costs were shown to have additional negative impacts on mental HRQoL. Food insufficiency is highly prevalent among people living with HIV in Ontario, particularly for those with unstable housing. This vulnerable group of individuals is in urgent need of changes to current housing programmes, services and policies, as well as careful consideration of their unmet nutritional needs.
authors.affiliation: a The Ontario HIV Treatment Network , Toronto , ON , Canada.|b Faculty of Medicine, Institute of Medical Science , University of Toronto , Toronto , ON , Canada.
authors.forename: Stephanie K Y
authors.initials: SK
authors.lastname: Choi
authors.affiliation: c School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fielden
authors.affiliation: a The Ontario HIV Treatment Network , Toronto , ON , Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Globerman
authors.affiliation: d Bruce House , Ottawa , ON , Canada.
authors.forename: J J Jay
authors.initials: JJ
authors.lastname: Koornstra
authors.affiliation: e Fife House , Toronto , ON , Canada.
authors.forename: Keith
authors.initials: K
authors.lastname: Hambly
authors.affiliation: f Positive Living Niagara , St. Catharines , ON , Canada.
authors.forename: Glen
authors.initials: G
authors.lastname: Walker
authors.affiliation: g AIDS Thunder Bay , Thunder Bay , ON , Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Sobota
authors.affiliation: h Lake Head University , Thunder Bay , ON , Canada.
authors.forename: Doe
authors.initials: D
authors.lastname: O'Brien-Teengs
authors.affiliation: a The Ontario HIV Treatment Network , Toronto , ON , Canada.
authors.forename: James
authors.initials: J
authors.lastname: Watson
authors.affiliation: a The Ontario HIV Treatment Network , Toronto , ON , Canada.
authors.forename: Tsegaye
authors.initials: T
authors.lastname: Bekele
authors.affiliation: i Faculty of Social Work , McMaster University , Hamilton , ON , Canada.
authors.forename: Saara
authors.initials: S
authors.lastname: Greene
authors.affiliation: j The AIDS Network , Hamilton , ON , Canada.
authors.forename: Ruthann
authors.initials: R
authors.lastname: Tucker
authors.affiliation: k Faculty of Medicine, Dalla Lana School of Public Health & Institute of Health Policy, Management and Evaluation , University of Toronto , Toronto , ON , Canada.|l Centre for Research on Inner City Health , Li Ka Shing Knowledge Institute , Toronto , ON , Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.affiliation: a The Ontario HIV Treatment Network , Toronto , ON , Canada.|l Centre for Research on Inner City Health , Li Ka Shing Knowledge Institute , Toronto , ON , Canada.|m Department of Psychiatry , University of Toronto , Toronto , ON , Canada.|n CIHR Centre for REACH in HIV/AIDS and Community Based Research Collaborative Centre , Toronto , ON , Canada.
authors.forename: Sean B
authors.initials: SB
authors.lastname: Rourke
authors.affiliation: a The Ontario HIV Treatment Network , Toronto , ON , Canada.
authors.forename: The Positive Spaces
authors.initials: TP
authors.lastname: Healthy Places Team
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition; D008875:Middle Aged; D009864:Ontario; D011203:Poverty; D011788:Quality of Life
keywords: HIV; Ontario; food insufficiency; housing; longitudinal design; quality of life