title: High perceived social standing is associated with better health in HIV-infected Ugandan adults on highly active antiretroviral therapy.
abstract: Perceived social standing (PSS) was evaluated as a determinant of differences in health outcomes among Ugandan HIV-infected adults from Kampala using cross-sectional study design. PSS was defined using the MacArthur scale of subjective social status translated and adapted for the study setting. Socio-demographic and psychosocial correlates of PSS ranking at enrollment were determined using linear regression models. High versus low PSS was defined based on the median PSS score and evaluated as a determinant of body mass index, hemoglobin, quality of life (QOL) and frailty-related phenotype via linear regression. A log-binomial regression model estimated the relative-risk of good, very good or excellent versus fair or poor self-rated health (SRH) in relation to PSS. Older age, increasing social support and material wealth were correlated with high PSS ranking, whereas female sex, experience of multiple stigmas and multiple depressive symptoms were correlated with low PSS ranking. High PSS participants were on average 1.1 kg/m(2) heavier, had 4.7 % lower frailty scores and 3.6 % higher QOL scores compared to low PSS patients (all p < 0.05); they were also more likely to self-classify as high SRH (RR 1.4, 95 % confidence interval 1.1, 1.7) but had comparable hemoglobin levels (p = 0.634). Low PSS correlated with poor physical and psychosocial wellbeing in HIV-positive Ugandan adults. The assessment of PSS as part of clinical management, combined with efforts to reduce stigma and improve social support, may identify and possibly reduce PSS-associated health inequality in Ugandan adults with HIV.
authors.affiliation: Department of Epidemiology and Biostatistics, The University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA, 30602, USA. aezeamam@uga.edu.
authors.forename: A E
authors.initials: AE
authors.lastname: Ezeamama
authors.affiliation: School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: D
authors.initials: D
authors.lastname: Guwatudde
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Wang
authors.affiliation: School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.|Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Bagenda
authors.affiliation: Department of Epidemiology and Biostatistics, The University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA, 30602, USA.
authors.forename: K
authors.initials: K
authors.lastname: Brown
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: R
authors.initials: R
authors.lastname: Kyeyune
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Smith
authors.affiliation: School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: H
authors.initials: H
authors.lastname: Wamani
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.|Division of Infectious Diseases, Department of Medicine, John Hopkins University, Baltimore, MD, USA.
authors.forename: Y C
authors.initials: YC
authors.lastname: Manabe
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.|Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.|Department of Nutrition, Harvard School of Public Health, Boston, MA, 02115, USA.
authors.forename: W W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012923:Social Class; D057545:Social Stigma; D012944:Social Support; D014454:Uganda
keywords: HIV/AIDS; Health-disparities; Perceived social standing; Subjective social status; Uganda