Geographic Differences in Social Determinants of Health Among US-Born and Non-US-Born Hispanic/Latino Adults With Diagnosed HIV Infection, United States and Puerto Rico, 2017

A Census Tract-Level Examination of Diagnosed HIV Infection and Social Vulnerability among Black/African American, Hispanic/Latino, and White Adults, 2018: United States

BACKGROUND

To reduce health disparities and improve the health of Americans overall, addressing community-level social and structural factors, such as social vulnerability, may help explain the higher rates of HIV diagnoses among and between race/ethnicity groups.

METHODS

Data were obtained from CDC's National HIV Surveillance System (NHSS) and the CDC/ATSDR social vulnerability index (SVI). NHSS data for Black, Hispanic/Latino, and White adults with HIV diagnosed in 2018 were linked to SVI data. To measure the relative disparity, rate ratios (RRs) with 95% CIs were calculated to examine the relative difference comparing census tracts with the lowest SVI scores (quartile 1, Q1) to those with the highest SVI scores (quartile 4, Q4) by sex assigned at birth for age group and region of residence. Differences in the numbers of diagnoses across the quartiles were analyzed by sex assigned at birth and transmission category.

RESULTS

There were 13,807 Black, 8747 Hispanic/Latino, and 8325 White adults who received a diagnosis of HIV infection in the United States in 2018-with the highest HIV diagnosis rates among adults who lived in census tracts with the highest vulnerability (Q4). For each race/ethnicity and both sexes, the rate of HIV diagnoses increased as social vulnerability increased. The highest disparities in HIV diagnosis rates by SVI were among persons who inject drugs, and the highest within-group RRs were typically observed among older persons and persons residing in the Northeast.

CONCLUSION

To reach the goals of several national HIV initiatives, efforts are needed to address the social vulnerability factors that contribute to racial and ethnic disparities in acquiring HIV and receiving care and treatment.

EFFECT OF SOCIAL DETERMINANTS OF HEALTH ON UNCONTROLLED HIV INFECTION AMONG PERSONS LIVING WITH HIV IN SAN FRANCISCO, CA, USA

Background

In 2010–2014, the San Francisco Department of Public Health (SFDPH) established programs to rapidly link people with human immunodeficiency virus (PWH) to care and offer antiretroviral therapy (ART) at human immunodeficiency virus (HIV) diagnosis. Such programs reduced the number of PWH out of care or with detectable HIV viral load (ie, uncontrolled HIV infection). We investigated the role of social determinants of health (SDH) on uncontrolled HIV.

Methods

Cross-sectional data from adult PWH diagnosed and reported to the SFDPH as of December 31, 2019, prescribed ART, and with confirmed San Francisco residency during 2017–2019 were analyzed in conjunction with SDH metrics derived from the American Community Survey 2015–2019. We focused on 5 census tract-level SDH metrics: percentage of residents below the federal poverty level, with less than a high school diploma, or uninsured; median household income; and Gini index. We compared uncontrolled HIV prevalence odds ratios (PORs) across quartiles of each metric independently using logistic regression models.

Results

The analysis included 7486 PWH (6889 controlled HIV; 597 uncontrolled HIV). Unadjusted PORs of uncontrolled HIV rose with increasingly marginalized quartiles, compared to the least marginalized quartile for each metric. Adjusting for demographics and transmission category, the POR for uncontrolled HIV for PWH in the most marginalized quartile remained significant across metrics for poverty (POR = 2.0; confidence interval [CI] = 1.5–2.6), education (POR = 2.4; CI = 1.8–3.2), insurance (POR = 1.8; CI = 1.3–2.5), income (POR = 1.8; CI = 1.4–2.3), and income inequality (POR = 1.5; CI = 1.1–2.0).

Conclusions

Beyond demographics, SDH differentially affected the ability of PWH to control HIV. Despite established care programs, PWH experiencing socioeconomic marginalization require additional support to achieve health outcome goals.