The associations of income and Black-White racial segregation with HIV outcomes among adults aged ≥18 years-United States and Puerto Rico, 2019.

OBJECTIVE(S): To examine associations between Index of Concentration at the Extremes (ICE) measures for economic and racial segregation and HIV outcomes in the United States (U.S.) and Puerto Rico. METHODS: County-level HIV testing data from CDC's National HIV Prevention Program Monitoring and Evaluation and census tract-level HIV diagnoses, linkage to HIV medical care, and viral suppression data from the National HIV Surveillance System were used. Three ICE measures of spatial polarization were obtained from the U.S. Census Bureau's American Community Survey: ICEincome (income segregation), ICErace (Black-White racial segregation), and ICEincome+race (Black-White racialized economic segregation). Rate ratios (RRs) for HIV diagnoses and prevalence ratios (PRs) for HIV testing, linkage to care within 1 month of diagnosis, and viral suppression within 6 months of diagnosis were estimated with 95% confidence intervals (CIs) to examine changes across ICE quintiles using the most privileged communities (Quintile 5, Q5) as the reference group. RESULTS: PRs and RRs showed a higher likelihood of testing and adverse HIV outcomes among persons residing in Q1 (least privileged) communities compared with Q5 (most privileged) across ICE measures. For HIV testing percentages and diagnosis rates, across quintiles, PRs and RRs were consistently greatest for ICErace. For linkage to care and viral suppression, PRs were consistently lower for ICEincome+race. CONCLUSIONS: We found that poor HIV outcomes and disparities were associated with income, racial, and economic segregation as measured by ICE. These ICE measures contribute to poor HIV outcomes and disparities by unfairly concentrating certain groups (i.e., Black persons) in highly segregated and deprived communities that experience a lack of access to quality, affordable health care. Expanded efforts are needed to address the social/economic barriers that impede access to HIV care among Black persons. Increased partnerships between government agencies and the private sector are needed to change policies that promote and sustain racial and income segregation.

Diagnoses of HIV infection among Hispanics/Latinos in 40 states and Puerto Rico, 2006-2009.

BACKGROUND: In the United States, Hispanics are disproportionately affected by HIV infection. However, Hispanic subgroups of varied national origin differ culturally and HIV may impact them differently. METHODS: We used information on Hispanics/Latinos diagnosed with HIV during 2006-2009 in 40 states and Puerto Rico, and aged ≥13 years, reported to the Centers for Disease Control and Prevention through June 2010, to examine the distribution of disease by selected characteristics, including place of birth and place of residence at diagnosis. We used Poisson regression to calculate the estimated annual percent change in the rate of HIV diagnoses and estimated prevalence ratios of a short HIV-to-AIDS interval (AIDS diagnosis within 12 months of HIV diagnosis). Analyses were adjusted for reporting delays and missing risk factor information. RESULTS: During 2006-2009, HIV infection was diagnosed among 33,498 Hispanics/Latinos. From 2006 to 2009, the annual rate of diagnoses decreased among Hispanics/Latinos [estimated annual percent change = -4.3%; 95% confidence interval (CI) = -6.5 to -2.0) including men (-2.8%; 95% CI = -5.2 to -0.4) and women (-9.8%; 95% CI = -13.2 to -6.3). The rate of HIV diagnosis remained stable by place of birth but decreased among Puerto Ricans (-13.1%; 95% CI = -17.0 to -9.0). Among Hispanics/Latinos, a short HIV-to-AIDS interval was more common in nonurban areas than in urban areas. DISCUSSION: Diagnosis of HIV infection among Hispanics/Latinos decreased and HIV-to-AIDS intervals varied by place of birth and area of residence. To continue to decrease the incidence of HIV infection among Hispanics, prevention programs need to address cultural and regional differences.

Increases in HIV diagnoses at the U.S.-Mexico border, 2003-2006.

The population at the U.S.-Mexico border has experienced growth, more than double the U.S. national average. Movements of populations in this region have contributed to increased incidence of certain infectious diseases. We used information on persons diagnosed with HIV during 2003 to 2006 and aged 13 years or older (n = 4,279) reported to the Centers for Disease Control and Prevention for 45 U.S. border counties. We estimated the annual percent change and rates with Poisson regression. Overall, 47% of persons diagnosed with HIV in the border region were Hispanic; 39% nonHispanic white; and 10% nonHispanic black. During 2003 to 2006, HIV diagnoses increased 7.8% per year. Increases were observed among males, particularly among men who have sex with men. Among females, HIV diagnoses remained stable but decreased among females in nonborder regions. The number of HIV diagnoses at the border has increased. To decrease incidence of HIV disease it is necessary to develop prevention and education programs specific to this region.

Characteristics of HIV infection among Hispanics, United States 2003-2006.

BACKGROUND: Hispanic subgroups of varied national origin differ culturally; overall, Hispanics in the United States are disproportionately affected by HIV infection. METHODS: We analyzed cases of HIV infection that were diagnosed among Hispanics in 33 states and US-dependent areas during 2003-2006 and reported to the Centers for Disease Control and Prevention through June 2007. We used Poisson regression to calculate the estimated annual percent change in the number and rate of HIV diagnoses and used logistic regression to analyze the association between birthplace and a short (<12 months) HIV-to-AIDS interval. RESULTS: HIV infection was diagnosed among 30,415 Hispanics. Of 24,313 with reported birthplace, 61% were born outside the continental United States. The annual number of diagnoses increased among Mexican-born males [estimated annual percent change = 8.8%; 95% confidence interval (CI) = 3.5 to 14.5] and Central American-born males (18.6%; 95% CI = 9.4 to 28.6) and females (24.6%; 95% CI = 8.8 to 42.7) but decreased among US-born Hispanic females (-8.2%; 95% CI = -13.3 to -2.8). A short HIV-to-AIDS interval was more common among Mexican-born Hispanics than among US-born Hispanics. DISCUSSION: Diagnosis trends and HIV-to-AIDS intervals varied by place of birth. To decrease the incidence of HIV infection among Hispanics, prevention programs need to address cultural differences.