A census tract-level examination of social determinants of health among black/African American men with diagnosed HIV infection, 2005-2009--17 US areas.

HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men (collectively referred to as MSM). A better understanding of the social conditions in which black men live and work may better explain why HIV incidence and diagnosis rates are higher than expected in this population.Using data from the National HIV Surveillance System and the US Census Bureau's American Community Survey, we examined the relationships of HIV diagnosis rates and 5 census tract-level social determinants of health variables for 21,948 black MSM and non-MSM aged ≥ 15 years residing in 17 areas in the United States. We examined federal poverty status, marital status, education level, employment status, and vacancy status and computed rate ratios (RRs) and prevalence odds ratios (PORs), using logistic regression with zero-inflated negative binomial modeling.Among black MSM, HIV diagnosis rates decreased as poverty increased (RR: 0.54). At the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts with a higher proportion below the poverty level (POR: 0.81) and with a higher proportion of vacant houses (POR: 0.86). In comparison, housing vacancy was positively associated with HIV diagnosis rates among black non-MSM (RR: 1.65). HIV diagnosis rates were higher for black MSM (RR: 2.75) and non-MSM (RR: 4.90) whose educational level was low. Rates were significantly lower for black MSM (RR: 0.06) and non-MSM (RR: 0.26) as the proportion unemployed and the proportion married increased.This exploratory study found differences in the patterns of HIV diagnosis rates for black MSM and non-MSM and provides insight into the transmission of HIV infection in areas that reflect substantial disadvantage in education, housing, employment, and income

The associations of income and Black-White racial segregation with HIV outcomes among adults aged ≥18 years-United States and Puerto Rico, 2019.

Objective(s)To examine associations between Index of Concentration at the Extremes (ICE) measures for economic and racial segregation and HIV outcomes in the United States (U.S.) and Puerto Rico.MethodsCounty-level HIV testing data from CDC's National HIV Prevention Program Monitoring and Evaluation and census tract-level HIV diagnoses, linkage to HIV medical care, and viral suppression data from the National HIV Surveillance System were used. Three ICE measures of spatial polarization were obtained from the U.S. Census Bureau's American Community Survey: ICEincome (income segregation), ICErace (Black-White racial segregation), and ICEincome+race (Black-White racialized economic segregation). Rate ratios (RRs) for HIV diagnoses and prevalence ratios (PRs) for HIV testing, linkage to care within 1 month of diagnosis, and viral suppression within 6 months of diagnosis were estimated with 95% confidence intervals (CIs) to examine changes across ICE quintiles using the most privileged communities (Quintile 5, Q5) as the reference group.ResultsPRs and RRs showed a higher likelihood of testing and adverse HIV outcomes among persons residing in Q1 (least privileged) communities compared with Q5 (most privileged) across ICE measures. For HIV testing percentages and diagnosis rates, across quintiles, PRs and RRs were consistently greatest for ICErace. For linkage to care and viral suppression, PRs were consistently lower for ICEincome+race.ConclusionsWe found that poor HIV outcomes and disparities were associated with income, racial, and economic segregation as measured by ICE. These ICE measures contribute to poor HIV outcomes and disparities by unfairly concentrating certain groups (i.e., Black persons) in highly segregated and deprived communities that experience a lack of access to quality, affordable health care. Expanded efforts are needed to address the social/economic barriers that impede access to HIV care among Black persons. Increased partnerships between government agencies and the private sector are needed to change policies that promote and sustain racial and income segregation

Prevalence odds ratios^a of HIV infection diagnosis for black/African American MSM vs. non-MSM, by selected census tract-level social determinants of health (SDH), 2005–2009—17 areas.

<p>Note. Data include persons with diagnosed HIV infection regardless of stage of disease at diagnosis. HIV diagnosis data were statistically adjusted for missing transmission category, but not for reporting delays or incomplete reporting. All results for each outcome of interest in the models are based on controlling for all other variables.</p><p>MSM, men who reported ever having had sexual contact with other men.</p><p>CI, confidence interval.</p>a<p>Black non-MSM is the reference group.</p>b<p>The prevalence odds is defined as (#MSM+1)/(#non-MSM+1), where adding 1 to both the numerator and the denominator avoids the prevalence odds undefined when there are no diagnosed HIV infections among black non-MSM. PORs>1 indicates that among black males, as the proportion of a SDH variable of interest increases, the probability of black MSM diagnosed with HIV is higher compared to black non-MSM.</p><p>Prevalence odds ratios^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0107701#nt110" target="_blank">a</a>} of HIV infection diagnosis for black/African American MSM vs. non-MSM, by selected census tract-level social determinants of health (SDH), 2005–2009—17 areas.</p

Diagnoses of HIV infection among black/African American MSM and non-MSM, by age at diagnosis, 2005–2009—17 areas.

<p>Note. Data include persons with diagnosed HIV infection regardless of stage of disease at diagnosis. HIV diagnosis data were statistically adjusted for missing transmission category, but not for reporting delays or incomplete reporting.</p><p>MSM, men who reported ever having had sexual contact with other men.</p>a<p>Rates are per 100,000 population.</p><p>Diagnoses of HIV infection among black/African American MSM and non-MSM, by age at diagnosis, 2005–2009—17 areas.</p

Differences in Selected HIV Care Continuum Outcomes Among People Residing in Rural, Urban, and Metropolitan Areas—28 US Jurisdictions

Purpose: The HIV care continuum is used to monitor success in HIV diagnosis and treatment among persons living with HIV in the United States. Significant differences exist along the HIV care continuum between subpopulations of people living with HIV; however, differences that may exist between residents of rural and nonrural areas have not been reported. Methods: We analyzed the Centers for Disease Control and Prevention’s National HIV Surveillance System data on adults and adolescents (\u3e13 years) with HIV diagnosed in 28 jurisdictions with complete reporting of HIV-related lab results. Lab data were used to assess linkage to care (\u3e1 CD4 or viral load test \u3c3 months of diagnosis), retention in care (\u3e2 CD4 and/or viral load tests \u3e3 months apart), and viral suppression (viral load \u3c200 copies/mL) among persons living with HIV. Residence at diagnosis was grouped into rural (\u3c50,000 population), urban (50,000-499,999 population), and metropolitan (\u3e500,000 population) categories for statistical comparison. Prevalence ratios and 95% CI were calculated to assess significant differences in linkage, retention, and viral suppression. Findings: Although greater linkage to care was found for rural residents (84.3%) compared to urban residents (83.3%) and metropolitan residents (81.9%), significantly lower levels of retention in care and viral suppression were found for residents of rural (46.2% and 50.0%, respectively) and urban (50.2% and 47.2%) areas compared to residents of metropolitan areas (54.5% and 50.8%). Conclusions: Interventions are needed to increase retention in care and viral suppression among people with HIV in nonmetropolitan areas of the United States

HIV diagnosis rate ratios among black/African American MSM and non-MSM, by selected census tract–level social determinants of health, 2005–2009—17 areas.

<p>Note. Data include persons with diagnosed HIV infection regardless of stage of disease at diagnosis. HIV diagnosis data were statistically adjusted for missing transmission category, but not for reporting delays or incomplete reporting. All results for each outcome of interest in the models are based on controlling for all other variables.</p><p>MSM, men who reported ever having had sexual contact with other men.</p><p>CI, confidence interval.</p><p>HIV diagnosis rate ratios among black/African American MSM and non-MSM, by selected census tract–level social determinants of health, 2005–2009—17 areas.</p