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

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

Yusuf Ransome  1 , Ichiro Kawachi  2 , Sarah Braunstein  3 , Denis Nash  4
Affiliations
Comparative Study

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

Yusuf Ransome et al. Health Place. 2016 Nov.

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.

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Figures

Fig. 1
Fig. 1
Heuristic model given the body of empirical evidence on the topic showing the proposed direction of associations among neighborhood income inequality, socioeconomic deprivation, black racial concentration, and the mediating associations of HIV testing on late HIV diagnosis.
Fig. 2
Fig. 2
Scatter plot and linear fit between income inequality (x) and late HIV diagnosis rates (y) at the ZIP codes (n=174) Reference lines are dashed (X=0.41 for average Census 2000 GINI) and (Y=10.3 for average late HIV diagnosis rate 2009–10). Bold triangles highlight select ZIP codes across four quadrants.
Fig. 3
Fig. 3
Choropleth maps (from top left to right) of Black racial concentration overlaid with late HIV diagnosis rates, HIV testing prevalence overlaid with location of HIV testing centers, income inequality, and socioeconomic deprivation index across, NYC ZIP codes (n=174). Selected ZIP codes on the income inequality map correspond to those in Fig. 2 and Supplement Table 1.
See this image and copyright information in PMC

References

    1. Adimora AA, Schoenbach VJ. Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. J Infect Dis. 2005;191:S115–S122. - PubMed
    1. AIDSVU. Illustrating HIV/AIDS in the United States [Online] AIDSVu; 2014. Available: ( http://aidsvu.org/wp-content/uploads/data-sets/AIDSVu-USA.pdf) (accessed 21.05.14)
    1. AIDSVU. City and state profiles [Online] AIDSVu; 2016. Available: ( http://aidsvu.org/local-statistics/) (accessed 18.01.16)
    1. Alba R, Romalewski S. The end of segregation? Hardly [Online] New York City: Center for Urban Research; 2012. Available: ( http://www.gc.cuny.edu/Page-Elements/Academics-Research-Centers-Initiati...) (accessed 30.01.16)
    1. Allison PD. Fixed Effects Regression Models. SAGE Publications Inc; Thousand Oaks, CA: 2009.

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