AIDS and Behavior

, Volume 22, Issue 7, pp 2214–2223 | Cite as

Elevated Mortality and Associated Social Determinants of Health in a Community-Based Sample of People Living with HIV in Ontario, Canada: Findings from the Positive Spaces, Healthy Places (PSHP) Study

  • Tsegaye Bekele
  • Jason Globerman
  • James Watson
  • Stephen W. Hwang
  • Keith Hambly
  • Jay Koornstra
  • Glen Walker
  • Jean Bacon
  • Sean B. Rourke
  • The Positive Spaces Healthy Places Study Team
Original Paper


We examined social determinants of health associated with all-cause mortality among 602 people living with HIV/AIDS in Ontario, Canada. Mortality status was verified at 1-, 3-, and 5-year follow-up visits with information obtained from proxies (family members, partners, and friends), obituaries, and local AIDS memorial lists. Of the 454 people for whom mortality information was available, 53 individuals died yielding a crude mortality rate of 22.3 deaths per 1000 person-years, a rate substantially higher than the rate in the general population (6.8 per 1000 population). Experiencing both homelessness and incarceration independently predicted high risk of mortality among men who have sex with men (MSM) while suboptimal self-rated general health at previous visit predicted higher greater risk of mortality in both MSM and women and heterosexual men. Homelessness and incarceration may contribute to HIV disease progression and mortality. Intensive case management that increases retention in care and facilitates linkage to housing services may help to reduce excess deaths among people with HIV.


Social determinants of health Mortality HIV Homelessness Incarceration 



The authors wish to thank Wayne Bristow, Lynne Cioppa, Jasmine Cotnam, Scott de Blois, James Gough, R.K, J. Lauzon, Mary Mwalwanda, Rumaldo Rincon, Stephanie Smith, T. Walker, James Watson, and Pius White who conducted the face-to-face interviews. We also gratefully acknowledge the study participants and the community-based AIDS service organizations in Ontario for their sustained support to the PSHP study. Members of the PSHP Study Team: Sean B. Rourke; Saara Greene; Keith Hambly; Stephen W. Hwang; Jay Koornstra; Frank McGee; Doe O’Brien-Teengs; Michael Sobota; Ruthann Tucker; Glenn Walker.


The Positive Spaces, Healthy Places study is supported by grants from the Canadian Institutes of Health Research (CBR-75568 and CBR-94036), the Ontario Ministry of Health and Long Term Care, the Ontario AIDS Network, the Wellesley Institute, and the Ontario HIV Treatment Network (CCB115).

Compliance with Ethical Standards

Conflicts of interest

All authors declare no conflicts of interest.

Ethical Approval

The PSHP study has received approval from ethics review boards of the University of Toronto and McMaster University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individuals included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Tsegaye Bekele
    • 1
  • Jason Globerman
    • 1
  • James Watson
    • 2
  • Stephen W. Hwang
    • 2
    • 3
  • Keith Hambly
    • 4
  • Jay Koornstra
    • 5
  • Glen Walker
    • 6
  • Jean Bacon
    • 1
  • Sean B. Rourke
    • 2
    • 7
  • The Positive Spaces Healthy Places Study Team
  1. 1.The Ontario HIV Treatment NetworkTorontoCanada
  2. 2.Centre for Urban Health Solutions, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  3. 3.Department of MedicineUniversity of TorontoTorontoCanada
  4. 4.Fife HouseTorontoCanada
  5. 5.Bruce HouseOttawaCanada
  6. 6.Positive Living NiagaraSt. CatharinesCanada
  7. 7.Department of PsychiatryUniversity of TorontoTorontoCanada

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