Identifying social structural factors associated with HIV community based organization service use and community participation among women living with HIV in Metro Vancouver

Abstract

Abstract Background HIV Community-Based Organizations (CBOs) remain underfunded, limiting programming and support, with limited research examining factors influencing women’s engagement with HIV CBOs. Therefore, social-structural factors associated with HIV CBO service use and community participation were investigated among women living with HIV to inform engagement strategies that optimize resource allocation amid funding constraints. Methods Data were drawn from the Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA) study of 389 cisgender (cis) andtransgender (trans) women living with HIV in Metro Vancouver (September/2014-February/2025). Bivariate/multivariable logistic regressions examined associations between social-structural factors, HIV CBO service use, and community participation. Sample 1 included 270 women (1445 observations;2019–2024) and sample 2 included 227 women (984 observations;2020–2024). Adjusted odds ratios (aORs) were reported with 95% confidence intervals. Missing data were addressed using multiple imputations. Results Sample 1 median age was 48 years (Q1-Q3:40–54) ( n = 270). Overall, 54.1% ( n = 146) were Indigenous, 33.3% ( n = 90) White, and 12.6% ( n = 34) were racialized/women of colour. In multivariable analysis for the outcome of HIV CBO service use, women who were older (aOR:1.04[1.01–1.06](per year)), Indigenous (aOR:1.71[1.07–2.75]), racialized/women of colour (aOR:2.43[1.25–5.60]) (vs. White), reported PTSD (vs. no PTSD) (aOR: 1.62 [1.11–2.37]), and food insecure (vs. food secure) (aOR:1.42 [1.13–1.78]) had higher odds of HIV CBO service use. Among multivariable analysis for the outcome of HIV CBO community participation, older age (aOR:1.06[1.02–1.10](per year)) and graduated high school (vs. did not graduate) (aOR:2.23[1.18–4.23]) had higher odds of HIV CBO community participation, while criminalized substance use (vs. none) had lower odds (aOR:0.56[0.37–0.84]). Discussion Study findings suggest that strategies to support services that engage older, Indigenous, racialized/women of colour, and food insecure populations of women continue to be needed, including sustained funding commitments. Strategies to engage women who are younger, use criminalized substances, and did not graduate high school is recommended.