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Employment by HIV status, mode of HIV transmission and migrant status: a nation-wide population-based study with twenty years of follow-up.

OBJECTIVE
To compare employment in people by HIV status, mode of HIV transmission and migrant status.


DESIGN
Nation-wide population-based register data from 1996 to 2016.


METHODS
All people born between 1940 and 2000 (n = 8 587 629) were identified from the Swedish Total Population Register and linked to the Swedish National HIV Register (n = 9 492) and Longitudinal Integration Database for Health Insurance and Labour Market Studies. Adjusted prevalence ratios (adjPR) of employment were calculated using Poisson regression. Trends in employment were illustrated in scatterplots with overlaid prediction plots.


RESULTS
People with HIV were less likely employed than HIV-negative but with decreasing difference over time (adjPR 0.57, 95% CI 0.54-0.60 in 1996, adjPR 0.84, 95% CI 0.83-0.86 in 2016). Female migrants with HIV had the highest increase of employment over time and were more likely employed than HIV-negative female migrants by end of follow-up (adjPR 1.12, 95% CI 1.08-1.16). Swedish-born with present/former intravenous drug use had the lowest employment rates. Individuals with undetectable HIV-RNA viral levels showed higher employment rates (adjPR 1.29, 95% CI 1.20-1.38) compared to those with detectable viral levels.


CONCLUSIONS
Employment in PLWH increased over time but remained lower than for HIV-negative people. HIV was not associated with lower employment in migrants by end of follow-up, indicating that HIV is not a barrier for employment among migrants in Sweden. The heterogeneity of PLWH needs to be taken into account in interventions, and future studies, focusing on access to the labour market in PLWH.