In 2024, the World Health Organization (WHO) released a report listing 2021’s leading causes of death worldwide. Unsurprisingly, at a global scale, ischaemic heart disease remains at the top of the list, with COVID-19 not far behind. However, when data was divided between high- and low-income countries, leading causes of death diverged. Human immunodeficiency virus (HIV) is one such example. Still listed as the 10th leading cause of death in low-income countries, the HIV epidemic continues to kill hundreds of thousands each year—yet in Canada, there were only 126 deaths directly affiliated with HIV in 2023.
HIV does not yet have a cure, but it can be treated. Most treatment plans use antiretroviral therapy to control virus levels, ultimately reducing symptoms and making patients’ viral loads low enough to prevent it from being detectable or sexually transmittable. Through access to these treatment plans, Canadians with HIV are able to live long, healthy lives with significantly lower risk of severe infections.
However, while Canadians are largely protected from HIV through national health infrastructure and insurance, many migrants are denied this protection. Dr. Bertrand Lebouché and his PhD student Moustafa Laymouna explored this care gap in a recent study. In their paper, published in HIV Medicine, the two researchers explored the link between Canadian migrants’ material deprivation—a poverty standard—and their HIV clinical outcomes.
“There are studies that talk about the relationship and the link between clinical HIV outcomes and material deprivation. [However], no study has been conducted in a context [focusing on] migrants, or the barriers that we try to remove for these participants,” Laymouna explained in an interview with The Tribune. “This is what makes our study more interesting and new.”
Taking place over the course of a year, Lebouché and Laymouna measured the material deprivation of 48 participants at the 4- and 48-week mark. Patients were provided with free HIV medication, along with further medical support such as access to pharmacists, doctors, and social workers.
At each check-in, the effect of patients’ material deprivation on their clinical outcomes was measured—a relationship that research has shown to be negatively correlated. Previous literature shows that material deprivation leads to poor clinical outcomes, as poverty can create additional barriers within care.
Critically, this relationship was not confirmed in Lebouché and Laymouna’s study. Instead, there was no statistically significant relationship between material deprivation and HIV clinical results.
“We saw that there is almost no significant impact in [the participants’] clinical outcome, so it means two things,” Lebouché said. “First, they are very resilient people. It means that they fight a lot to survive in Canada, to survive in Quebec, and they succeed [….] They still are very poor, but they survive. And the second reason is possibly because we give them good care [….] The focus of our research team is patient-centered care [and] patient-centered research [….] [We] give medication on site, free of charge, and […] [patients] see pharmacists, nurses, physicians, social workers, and psychologists or psychiatrists.”
These findings underscore the importance of accessible public health infrastructure. Consistent access to affordable care counteracted the negative health effects of material deprivation, allowing for these patients to have significantly better treatment outcomes.
Lebouché and Laymouna’s study highlighted that overcoming systemic barriers is necessary to improve patient outcomes in Canada. By providing vulnerable communities with additional support, HIV treatments were successful. By investing in support systems, Canadian health practitioners can make a significant difference in the lives of those with HIV; in countries like Canada, where transmission rates have been reduced, improving clinical outcomes and livelihoods is the next step in combatting the global HIV epidemic.
“Something we push for [is that] antiretroviral therapy needs to be free for patients,” Lebouché explained. “Of the characteristics of this population, it’s very important that [patients] don’t have to choose to pay [for] their treatment, their care, or to pay to feed their family.”