Determinants of self-reported health and well-being among people living with HIV in the UK: a mixed methods exploration of the impact of structural and social factors


Supervisor: Prof. Helen Ward

Non-accademic partner: HIV Section, National Infection Service, Public Health England

The treatment and care of people living with HIV has significantly improved in the past two decades across the UK. These advancements now mean that HIV is a chronic, manageable condition and people living with HIV can anticipate a normal life expectancy. While treatment can be very effective, variations in health and well-being persist. This variation may reflect differences in clinical stage at diagnosis, management of other health conditions (co-morbidities) as well as broader social determinants. People living with HIV have also described an unmet need in social and welfare services provided, including housing, immigration and employment support. Many of these services have had reduced funding in recent years alongside changes in government policies.

This project will investigate why differences exist for the health and wellbeing of people living with HIV, and how much this can be explained by a person’s economic and social circumstances (their social determinants). We will also explore whether recent changes in public policies, including those related to the reported “hostile environment” for immigration, have affected the experiences faced by people living with HIV when accessing social and welfare services in the UK.

We will use two main methods to explore these differences; firstly, analysing data from a survey conducted in 2017 by Public Health England (PHE) of over 4,000 adults living with HIV in the UK, the Positive Voices study. We will link this data with the HIV and AIDS Reporting System (HARS) to explore the association between these different levels of determinants and clinical outcomes through multi-level modelling. Secondly, we will conduct in-depth interviews, observations and/or focus groups with key stakeholders including community organisations, service providers and policymakers. We will work closely with an advisory group of people living with HIV to help guide our research as it develops, and who will be involved in each step of the study – designing our approach, guiding analysis and interpretation, and disseminating results. This will be in line with the community-led Changing Perceptions project between PHE, Positively UK and NAT.

The findings will provide evidence to inform clinical care, future research and health policy to improve the experience of people living with HIV accessing health and social care services, as well as end-user organisations that support people living with HIV in the UK.