Abstract
To determine which county-level social, economic, demographic, epidemiologic and access to care factors are associated with Latino/non-Latino White disparities in prevalence of diagnosed HIV infection. We used 2016 county-level prevalence rates of diagnosed HIV infection rates for Latinos and non-Latino Whites obtained from the National HIV Surveillance System and factors obtained from multiple publicly available datasets. We used mixed effects Poisson modeling of observed HIV prevalence at the county-level to identify county-level factors that explained homogeneous effects across race/ethnicity and differential effects for Latinos and NL-Whites. Overall, the median Latinos disparity in HIV prevalence is 2.4; 94% of the counties have higher rates for Latinos than non-Latinos, and one-quarter of the counties' disparities exceeded 10. Of the 41 county-level factors examined, 24 showed significant effect modification when examined individually. In multi-variable modeling, 11 county-level factors were found that significantly affected disparities. Factors that increased disparity with higher, compared to lower values included proportion of HIV diagnoses due to injection drug use, percent Latino living in poverty, percent not English proficient, and percent Puerto Rican. Latino disparities increased with decreasing percent severe housing, drug overdose mortality rate, percent rural, female prevalence rate, social association rate, percent change in Latino population, and Latino to NL-White proportion of the population. These factors while significant had minimal effects on diminishing disparity, but did substantially reduce the variance in disparity rates. Large differences in HIV prevalence rates persist across almost all counties even after controlling for county-level factors. Counties that are more rural, have fewer Latinos, or have lower NL-White prevalence rates tend to have higher disparities. There is also higher disparity when community risk is low.
Highlights
Latinos/Hispanics in the U.S are disproportionately affected by HIV
Large differences in HIV prevalence rates persist across almost all counties even after controlling for county-level factors
According to the most recent report from the Centers for Disease Control and Prevention (CDC), the percentage of people living with HIV who are unaware of their HIV status is higher among Latinos compared with NL-Whites (16.7% vs. 11.5%) [5]
Summary
Latinos/Hispanics in the U.S are disproportionately affected by HIV. Latinos comprise 18% of the population, they accounted for 25% of newly diagnosed HIV infections in 2016 [1]. The prevalence rate of diagnosed HIV infection for Latinos in 2016 was 372.1 per 100,000, a rate nearly 2.5 times that of NL-Whites (152.8 per 100,000). According to the most recent report from the Centers for Disease Control and Prevention (CDC), the percentage of people living with HIV who are unaware of their HIV status is higher among Latinos compared with NL-Whites (16.7% vs 11.5%) [5]. Latinos are nearly equal to NL-Whites in the percentage linked to HIV medical care within one month of HIV diagnosis (79.3% vs 81.3%), while the percentage who have received any medical care (71.9% vs 77.8%%), and the percentage living with diagnosed HIV infection who are virally suppressed (61.3% vs 67.8%) are lower for Latinos. Latinos’ delayed entry into care resulting from undiagnosed HIV infection, and lower percentage of viral suppression may partially explain Latino HIV incidence and prevalence disparities. This paper examines the role of multiple social and demographic factors that may help explain variations in Latino HIV prevalence and disparities in the US at the county-level
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call