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September 18, 2025Open Access

Intersecting social determinants of health, multimorbidity and quality of life in people of Black ethnicities with HIV in South London: a mixed-methods study

Key Points

An increase in social determinant burden scores correlated with higher odds of multimorbidity in the population studied.
Three primary patterns of social determinants were identified: Livelihood, Shelter/Displacement, and Social Exclusion.
Qualitative insights supported quantitative findings, emphasizing the complexity of how social factors impact health outcomes.
Recommendations highlight the urgent need for comprehensive interventions to address health inequities faced by this group.

Abstract

Background: Social determinants of health (SDoH) impact health outcomes and rarely exert their influence in isolation. We examined associations between SDoH patterns, multimorbidity, and quality of life (QoL) in people of Black ethnicities with HIV in England. Methods: This mixed-methods study comprised questionnaires, focus group discussions and semi-structured interviews with staff members from a community-based organisation. We used principal component analysis to identify patterns of SDoH and z-scores to describe the burden of each pattern. Associations between SDoH burden scores, multimorbidity and QoL (EQ-5D) were assessed using logistic regression, adjusting for sex and age. Results: Amongst 340 participants (median interquartile range, IQR age 52 45–57 years, 54% female, 95% HIV RNA <200 copies/ml), we identified three SDoH patterns: Livelihood (food, employment and financial insecurity, loneliness and isolation), Shelter/Displacement (housing, migration and food insecurity) and Social Exclusion (discrimination, loneliness and isolation). An increase in SDoH z-scores was associated with higher odds of multimorbidity (Livelihood: aOR 2.09 1.63–2.69, Shelter/Displacement: 1.41 1.12–1.78, Social Exclusion: 1.78 1.40–2.26). Higher Livelihood and Social Exclusion z-scores correlated with all QoL domains (p<0.001), and Shelter/Displacement was associated with problems with usual activity (aOR 1.29 1.04–1.61, p = 0.02) and pain/discomfort (1.29 1.05–1.58, p = 0.02). Qualitative findings supported the quantitative findings whilst providing further context on how SDoH intersect and shape health. Conclusion: This study highlights how SDoH intersect and are associated with multimorbidity and lower QoL in people of Black ethnicities living with HIV. These findings emphasise the need for comprehensive, biopsychosocial interventions to address health inequities in this population.

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