Relationships between income level and work, service use, and informal relations among people living with HIV/AIDS

Olivier, Claude A. (2003) Relationships between income level and work, service use, and informal relations among people living with HIV/AIDS. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

The relationship between income and health is well established. However, we do not fully understand how various factors related to income lead to poor health. This study explores how people living with HIV/AIDS (PHAs) of various income levels experience paid and volunteer work, the use of private, government and non-profit services, and informal social relations. Through the use of semi-structured interviews, qualitative data was collected from 27 PHAs residing in the Maritime Provinces. Participants reported a number of psychosocial stressors linked to low income. This was evident in all three social domains explored. Low-income participants faced the greatest range of barriers to paid employment (e.g., lack of training and education). Those with long term low-income had fewer volunteer opportunities, likely related to not having acquired desirable skills through participation in the workforce. Participants had to rely on public income security programs that many found insufficient to their basic needs. Newly low-income participants described assertiveness and communication skills (likely acquired through paid work) that helped in obtaining maximum income assistance benefits. Participants with long term low-income may not have had opportunity to develop these skills. Low income participants had less access to private services to help maintain their health (e.g., complementary therapies, psychosocial counselling and fitness centres). In this study, negative HIV -related interactions with family and community members were more common among low-income participants. Participants connected this to people's lack of knowledge about HIV/AIDS and discomfort or judgement regarding homosexuality. Furthermore, low-income participants did not always have the money to visit or call family and friends, and to participate in community events. Overall, and in comparison to those with higher incomes, low-income participants experienced a greater range of stressors and had less control in addressing these stressors. This resulted in isolation and threats to self-worth; factors that are known to negatively impact upon health and wellbeing. For PHAs to meet their aspirations in paid or volunteer work, use of services, and informal social relations attention must be paid to oppression at individual, cultural and structural levels of society. Policy and program design must also focus on sources of stress, on factors that affect control over stressful life events, and on barriers to social engagement. Findings support the need for a population health approach to include an anti-oppressive analysis in exploring health inequities between population groups.

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