Connecting race and place: a county-level analysis of White, Black, and Hispanic HIV prevalence, poverty, and level of urbanization.
OBJECTIVE
We evaluated the role of poverty in racial/ethnic disparities in HIV prevalence across levels of urbanization.


METHODS
Using national HIV surveillance data from the year 2009, we constructed negative binomial models, stratified by urbanization, with an outcome of race-specific, county-level HIV prevalence rates and covariates of race/ethnicity, poverty, and other publicly available data. We estimated model-based Black-White and Hispanic-White prevalence rate ratios (PRRs) across levels of urbanization and poverty.


RESULTS
We observed racial/ethnic disparities for all strata of urbanization across 1111 included counties. Poverty was associated with HIV prevalence only in major metropolitan counties. At the same level of urbanization, Black-White and Hispanic-White PRRs were not statistically different from 1.0 at high poverty rates (Black-White PRR = 1.0, 95% confidence interval [CI] = 0.4, 2.9; Hispanic-White PRR = 0.4, 95% CI = 0.1, 1.6). In nonurban counties, racial/ethnic disparities remained after we controlled for poverty.


CONCLUSIONS
The association between HIV prevalence and poverty varies by level of urbanization. HIV prevention interventions should be tailored to this understanding. Reducing racial/ethnic disparities will require multifactorial interventions linking social factors with sexual networks and individual risks.
Adam S. Vaughan, Eli Rosenberg, and Patrick S. Sullivan are with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. R. Luke Shouse is with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Adam S
AS
Vaughan
Eli
E
Rosenberg
R Luke
RL
Shouse
Patrick S
PS
Sullivan
D001741:Black or African American; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology*; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D044465:White People