Poverty and unemployment common amongst HIV-positive Londoners

Many people with HIV in London are unemployed and live in poverty, according to a study published in the online edition of HIV Medicine. The investigators found that levels of hardship were greatest amongst HIV-positive individuals who were migrants or from ethnic minorities, but that significant numbers of white gay men were also unemployed or reported not having enough money to live on.

At the end of 2006 it was estimated that approximately 50,000 individuals were living with HIV in the UK. Over 80% of these infections affect gay men or black African heterosexuals. There are also significant numbers of infections amongst black Caribbeans and white heterosexuals.

There is already some evidence pointing to higher levels of poverty and unemployment amongst HIV-positive individuals in the UK. Investigators at London’s City University and Homerton University Hospital wanted to establish a better understanding of social and economic hardship amongst people with HIV.

They therefore designed a study that included 1687 patients attending HIV outpatient clinics in north east London. The size and diversity of the sample allowed the investigators to compare levels of poverty and unemployment between the different groups affected by HIV. Although most of the patients included in the study were gay men or black African heterosexuals, the study also yielded some data regarding the social and economic circumstances of black Caribbeans and white heterosexuals with HIV.

The patients were asked to complete a questionnaire that enquired about their age, sex, ethnicity, sexual orientation, country of birth, length and security of residence in the UK, level of education, employment status, sources of income, and type of housing. The participants were also asked to say if they had enough money to live on.

To see if any health factors were related to poverty or unemployment, the investigators also enquired about the patients’ length of diagnosis with HIV, anti-HIV treatment history, treatment side-effects, the presence of lipodystrophy, viral load, CD4 cell count, and history of HIV-related hospitalisation.

Representative of the wider epidemiology of HIV in the UK, gay men constituted the largest group of patients, followed by black African women and men. The median age of patients was 38 years, and the median time since diagnosis with HIV was four years.

When the investigators analysed responses about ethnicity and place of birth they found that the black African patients came from 22 different countries, with 24% originating in Uganda and 23% in Zimbabwe. Unsurprisingly, the majority of white gay men (78%) were born in the UK, as were 37% of gay men from ethnic minorities. The gay men born outside the UK came from 55 different countries, with 11% born in western Europe.

As expected, the overwhelming majority of white gay men (98%) had secure residency in the UK, as did 81% of gay men from ethnic minorities. By contrast, only 53% of black African heterosexual men and 49% of black African women said their immigration status was secure.

In common with earlier studies, the investigators found that the majority of patients from all the communities had some form of higher education.

Despite this level of education, only 47% of individuals were employed. The investigators found that there was little difference between levels of employment between white and ethnic minority gay men (58% vs. 54%), but gay men were significantly more likely to be employed than black African heterosexual men (45%) and women (35%).

As well as having a lower level of education (p

Even after controlling for these factors, the investigators found that black African heterosexual men (p

The investigators further explored the relationship between unemployment and time since diagnosis with HIV. They found that even amongst patients diagnosed since effective anti-HIV treatment became available, there was a strong association with longer duration of HIV infection and unemployment. Amongst white gay men diagnosed with HIV for under two years, 79% were employed, but this fell to 64% for men diagnosed for three or four years, and to 58% for men who were diagnosed with HIV five-to-nine years before completing the survey.

When they restricted their analysis to men diagnosed with HIV before effective anti-HIV treatment became available, they found that only 34% of white gay men were in employment. A similar pattern was observed for ethnic minority gay men and for black African heterosexual men and women.

Although the majority of patients reported having enough money to cover their basic needs, there were once again significant differences between Africans and gay men.

The group most likely to report not having enough to live on were black African heterosexual men (41%), followed by black African heterosexual women (39%) compared to 23% of ethnic minority gay men and 10% of white gay men. As expected, unemployment was associated with not having enough money.

But even when the investigators restricted their analysis to those currently in employment they still found that black African heterosexual men (21%) and women (23%) were significantly more likely to report lacking money to cover their basic needs than ethnic minority (5%) and white (3%) gay men.

Next the investigators looked at housing. Levels of home ownership were well below the UK average (70%), with only 39% of white gay men saying they owned their own home, compared to 19% of ethnic minority gay men, 9% of black African heterosexuals men and 7% of black African women.

Although levels of homelessness were low (1 – 2%), approximately 10% of ethnic minority gay men and 9% of black African heterosexual men and women said they were staying with family or friends. There was also evidence of insecure housing, with approximately 20% of black African heterosexuals saying they had moved at least three times in the previous three years compared to 7% of white gay men and 9% of gay men from ethnic minorities.

The investigators also obtained information on black Caribbeans and white heterosexuals. They found that 34% of black Caribbeans were born in the UK, as were 70% of white heterosexuals. For patients born abroad, the median number of years of residence in the UK was ten years for white heterosexuals compared to 28 years for black Caribbean men and women. Most white heterosexual men (98%) and women (89%) had secure residency in the UK, with slightly lower levels of security observed amongst black Caribbean heterosexual men (85%) and women (67%).

Fewer than 50% of black Caribbeans and white heterosexual men and women were employed. The investigators found that 42% of black Caribbean heterosexual men and 38% of black Caribbean women reported not having enough money to cover their basic needs, compared to 27% of white heterosexual women and 16% of white heterosexual men.

About 20% of white and Caribbean heterosexuals reported owning their own home. Comparable numbers of white heterosexual men (10%), women (8%) and black Caribbean heterosexual men (8%) reported moving three or more times in the previous three years, the figure being slightly higher for black Caribbean women (15%).

“We found people with HIV in all groups faced social and economic hardship”, write the investigators, “however, black African heterosexual men and women consistently faced more challenges relating to employment, income, housing, and UK residency status than any other group.”

They conclude, “tackling poverty and unemployment among people living with HIV in London and elsewhere in the UK should be given priority by policy makers.”