Julio Sergio Gonzalez-Montaner
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Doctoral Student Supervision (Jan 2008 - Nov 2020)
Background: Little is known about the relationship between food insecurity and health outcomes among people living with HIV/AIDS. This dissertation therefore sought to: i) review global evidence regarding the associations between food insecurity and HIV outcomes; ii) assess the prevalence and correlates of food insecurity among HIV-positive individuals receiving antiretroviral therapy (ART) across British Columbia (BC); iii) examine the relationship between hunger and plasma HIV RNA suppression among illicit drug users receiving ART in Vancouver; and iv) investigate the potential impact of food insecurity on mortality among injection drug users (IDU) receiving ART in BC.Methods: Adults receiving ART in three BC-based observational studies completed interviewer-administered surveys eliciting information about socio-demographic profile, risk behavior, and health status, and consenting to database linkage for retrieval of clinical, laboratory and prescription information. Explanatory, confounder and survival models were built to investigate the associations between food insecurity and ART outcomes. Results: A growing body of literature suggests that food insecurity is associated with increased risk of HIV transmission, poor ART access, adherence, pharmacokinetic efficacy, immunologic and virologic response, and reduced survival (Chapter 2). In a sample of 457 individuals receiving ART across BC, food insecurity was reported by 71% and was independently associated with younger age, illicit drug use, low annual income, tobacco smoking and symptoms of depression in explanatory models (Chapter 3). Among 406 illicit drug users receiving ART in Vancouver, 63% reported hunger and 59% had suppressed viral loads. Hunger and virologic suppression were not independently associated in multivariate confounder models (Chapter 4). Among 254 IDU receiving ART across BC, 41% died between June 1998 and September 2011. Food insecurity was associated with a two-fold increased risk of death in adjusted survival models (Chapter 5). Conclusion: This dissertation reviewed current evidence and gaps in knowledge about the relationship between food insecurity and HIV outcomes. Results suggest an urgent need for evidence-based social and structural interventions to reduce food insecurity and associated harms among HIV-infected individuals in BC, particularly among illicit drug users. Public health efforts should consider evaluating the possible role of nutritional supplementation within existing harm reduction and HIV services.
This study explored relational and spiritual dimensions of parental grieving. Five bereaved parental couples participated in three sets of interviews over the course of approximately three months. The guiding research question for this study was, “how do spiritual/religious bereaved parents grieve jointly for their deceased child?” Data was collected using the qualitative action-project method and participants were asked how they grieved together for their deceased child and how their spirituality impacted their joint grieving. Joint grieving processes were identified and monitored over approximately three months. The data analysis was informed by the qualitative action project and an instrumental case study method. Joint grieving was described and enacted as goal-directed activities, including both planned and unplanned grieving actions and intended towards the development of an ongoing, relational representation of the deceased child and towards the authentic and vibrant relationships with the partner and the Divine. Joint grieving was facilitated through engaging in joint grieving rituals, sharing individual grieving actions with one’s partner, and accepting the individual grieving style of the partner. Joint grieving was impeded by experiences of disconnection from the significant others, and by various life extraneous stressors. The joint grieving projects were irreducibly related to the spiritual lives of bereaved parents. Their faiths shaped the continuing bonds with their deceased children, offered comfort and spiritual meaning in the midst of suffering and provided an avenue to express disappointment and anger over their loss. The findings offer theoretical, empirical and clinical import for the multi-disciplinary study of parental bereavement.