Abstract
BackgroundIn recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering.ObjectiveThe goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data.MethodsWe used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases.ResultsThere were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P<.05). In multivariable models for all HIV cases, HIV hotspots were significantly more likely to include urban census tracts (adjusted odds ratio [AOR] 2.01, 95% CI 1.20-3.37) and census tracts that had a higher proportion of African Americans (AOR 3.85, 95% CI 2.23-6.65). The HIV hotspots were less likely to include census tracts with residents who had less than a high school education (AOR 0.95, 95% CI 0.92-0.98), census tracts with residents belonging to two or more racial/ethnic groups (AOR 0.46, 95% CI 0.30-0.70), and census tracts that had a higher percentage of the population living below the poverty level (AOR 0.51, 95% CI 0.28-0.92).ConclusionsWe used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South.
Highlights
MethodsIn the United States, HIV infections cluster geographically [1,2]
JMIR Public Health Surveill 2018 | vol 4 | iss. 2 | e35 | p.1 race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters
Spatial epidemiological and geostatistical analyses can facilitate identification and characterization of HIV hotspot clusters down to the neighborhood level [6], which can be useful for targeting HIV prevention and care interventions in communities with high rates of HIV infection, and specific sociodemographic characteristics associated with clustering
Summary
In the United States, HIV infections cluster geographically [1,2]. Spatial epidemiological and geostatistical analyses can facilitate identification and characterization of HIV hotspot clusters down to the neighborhood level [6], which can be useful for targeting HIV prevention and care interventions in communities with high rates of HIV infection, and specific sociodemographic characteristics associated with clustering. Mississippi ranks ninth highest in rate of new HIV infections [2] and had the eighth-highest AIDS death rate of any state in the United States in 2016 [8]. Jackson, Mississippi, had the fifth-highest AIDS diagnosis rate in 2014 and ranked fourth for HIV infection among metropolitan areas in the United States. A recent study found that Jackson has the highest rate of new HIV infections among MSM of any city nationwide [11]. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering
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