Abstract
BackgroundHIV 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.MethodsUsing 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.ResultsAmong 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.ConclusionsThis 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.
Highlights
HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men
During 2005–2009, in the 17 HIV Supplemental Surveillance Project areas, HIV infection was diagnosed for 22,396 black males aged 15 years and older, and residential addresses had been geocoded to the census tract level in 18,330 census tracts for 98% (21,948) (Table 1)
We found that at the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts in which a higher proportion of persons were living below the poverty level
Summary
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). The rates of HIV infection are higher for black MSM than for MSM of any other race/ethnicity, research has shown no significant differences in the sexual risk behaviors of black and white MSM [4,5,6] This observation suggests that factors other than individual risk behavior are contributing to the rate disparity. These disproportionate rates of HIV may be partly explained by a better understanding of the social determinants that affect black men’s lives and work [7,8,9,10,11]. Social determinants of health (SDH) serve as accessible proxies for social factors (e.g., poverty, education, marital status, and employment) and physical environmental factors (e.g., property values, housing vacancies), and they allow us to contextualize HIV risk among at-risk populations [12,13,14,15]
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