Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing

Health Place. 2016 Nov:42:148-158. doi: 10.1016/j.healthplace.2016.09.004. Epub 2016 Oct 19.

Abstract

In the United States, research is limited on the mechanisms that link socioeconomic and structural factors to HIV diagnosis outcomes. We tested whether neighborhood income inequality, socioeconomic deprivation, and black racial concentration were associated with gender-specific rates of HIV in the advanced stages of AIDS (i.e., late HIV diagnosis). We then examined whether HIV testing prevalence and accessibility mediated any of the associations above. Neighborhoods with highest (relative to lowest) black racial concentration had higher relative risk of late HIV diagnosis among men (RR=1.86; 95%CI=1.15, 3.00) and women (RR=5.37; 95%CI=3.16, 10.43) independent of income inequality and socioeconomic deprivation. HIV testing prevalence and accessibility did not significantly mediate the associations above. Research should focus on mechanisms that link black racial concentration to HIV diagnosis outcomes.

Keywords: Black racial concentration; HIV testing; Income inequality; Late HIV diagnosis; Socioeconomic deprivation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Analysis of Variance
  • Black or African American
  • Delayed Diagnosis / statistics & numerical data*
  • Female
  • Geographic Information Systems
  • HIV Infections / diagnosis*
  • HIV Infections / epidemiology
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Income
  • Male
  • New York City / epidemiology
  • Poverty
  • Registries
  • Sex Distribution
  • Socioeconomic Factors
  • United States
  • Urban Population