Social determinants of health predict state incidence of HIV and AIDS: a short report

Abstract

There are approximately 1.2 million people living with HIV/AIDS (PLWHA) in the USA. Each year, there are roughly 50,000 new HIV diagnoses. The World Health Organization Commission on Social Determinants of Health (CSDH) identified several social determinants of health and health inequity (SDH) including childcare, education, employment, gender equality, health insurance, housing, and income. The CSDH also noted the significant impact the SDH can have on advocacy for social change, social interventions to reduce HIV prevalence, and health monitoring. The current analysis evaluated the predictive ability of five SDH for HIV and AIDS incidence on the state level. The SDH used in the analysis were education, employment, housing, income, and insurance; other SDH were not included because reliable and appropriate state-level data were not available. The results of multiple regression analyses indicate that the use of these five SDH create statistically significant models predicting HIV incidence (adjusted R2 = .54) and AIDS incidence (adjusted R2 = .37) and account for a sizable portion of the variance for each. Stepwise variable selection reduced the necessary SDH to two: (1) education and (2) housing. These models are also statistically significant and account for a notable portion of variance in HIV incidence (adjusted R2 = .55) and AIDS incidence (adjusted R2 = .40). These outcomes demonstrate that state-level SDH, particularly education and housing, offer significant explanatory power regarding HIV and AIDS incidence rates. Congruent with the recommendations of the CSDH, the results of the current analysis suggest that state-sponsored policy and social interventions should consider and target SDH, especially education and housing, in attempts to reduce HIV and AIDS incidence rates.