1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
ICF, Atlanta, GA, USA.
Public Health Rep. 2022 Mar-Apr;137(2):278-290. doi: 10.1177/0033354921990373. Epub 2021 Feb 25.
Social and structural factors, referred to as social determinants of health (SDH), create pathways or barriers to equitable sexual health, and information on these factors can provide critical insight into rates of diseases such as HIV. Our objectives were to describe and identify differences, by race/ethnicity and geography, in SDH among adults with HIV.
We conducted an ecological study to explore SDH among people with HIV diagnosed in 2017, by race/ethnicity and geography, at the census-tract level in the United States and Puerto Rico. We defined the least favorable SDH as the following: low income (<$40 000 in median annual household income), low levels of education (≥18% of residents have <high school diploma), high levels of poverty (≥19% of residents live below the federal poverty level), unemployment (≥6% of residents in the workface do not have a job), lack of health insurance (≥16% of residents lack health insurance), and vacant housing (≥15% of housing units are vacant).
HIV diagnosis rates increased 1.4 to 4.0 times among men and 1.5 to 5.5 times among women as census-tract poverty levels increased, education levels decreased, income decreased, unemployment increased, lack of health insurance increased, and vacant housing increased. Among racial/ethnic groups by region and SDH, we observed higher HIV diagnosis rates per 100 000 population among non-Hispanic Black (49.6) and non-Hispanic White (6.5) adults in the South and among Hispanic/Latino (27.4) adults in the Northeast than in other regions. We observed higher HIV diagnosis rates per 100 000 population among non-Hispanic Black (44.3) and Hispanic/Latino (21.1) adults than among non-Hispanic White (5.1) adults.
Our findings highlight the importance of SDH in HIV infection and support the need for effective, targeted local interventions to specific populations based on HIV diagnoses and prevalence to prevent infection and reduce racial/ethnic disparities.
社会和结构性因素，即健康的社会决定因素（SDH），为公平的性健康创造了途径或障碍，这些因素的信息可以为艾滋病等疾病的发病率提供重要的见解。我们的目标是描述和确定美国和波多黎各按种族/族裔和地理位置划分的艾滋病毒感染者的 SDH 差异。
我们进行了一项生态研究，以探索 2017 年在美国和波多黎各按种族/族裔和地理位置在普查区一级诊断出的艾滋病毒感染者的 SDH。我们将最不利的 SDH 定义为以下情况：低收入（中位数家庭年收入低于 40000 美元）、低教育水平（≥18%的居民没有高中文凭）、高贫困水平（≥19%的居民生活在联邦贫困线以下）、失业（≥6%的居民没有工作）、缺乏医疗保险（≥16%的居民缺乏医疗保险）和闲置住房（≥15%的住房单元为空置）。
随着普查区贫困水平的提高、教育水平的降低、收入的减少、失业的增加、缺乏医疗保险的增加和闲置住房的增加，男性的艾滋病毒诊断率增加了 1.4 至 4.0 倍，女性的艾滋病毒诊断率增加了 1.5 至 5.5 倍。在按区域和 SDH 划分的种族/族裔群体中，我们观察到南方非西班牙裔黑人（49.6）和非西班牙裔白人（6.5）成年人以及东北部西班牙裔/拉丁裔（27.4）成年人每 10 万人中的艾滋病毒诊断率较高，而其他地区则较低。我们观察到非西班牙裔黑人（44.3）和西班牙裔/拉丁裔（21.1）成年人的每 10 万人中的艾滋病毒诊断率高于非西班牙裔白人（5.1）成年人。
我们的研究结果强调了 SDH 在艾滋病毒感染中的重要性，并支持根据艾滋病毒诊断和流行率针对特定人群实施有效、有针对性的地方干预措施，以预防感染和减少种族/族裔差异。
