title: A census tract-level examination of social determinants of health among black/African American men with diagnosed HIV infection, 2005-2009--17 US areas.
abstract: BACKGROUND
  HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men (collectively referred to as MSM). A better understanding of the social conditions in which black men live and work may better explain why HIV incidence and diagnosis rates are higher than expected in this population.
  
  
  METHODS
  Using data from the National HIV Surveillance System and the US Census Bureau's American Community Survey, we examined the relationships of HIV diagnosis rates and 5 census tract-level social determinants of health variables for 21,948 black MSM and non-MSM aged ≥ 15 years residing in 17 areas in the United States. We examined federal poverty status, marital status, education level, employment status, and vacancy status and computed rate ratios (RRs) and prevalence odds ratios (PORs), using logistic regression with zero-inflated negative binomial modeling.
  
  
  RESULTS
  Among black MSM, HIV diagnosis rates decreased as poverty increased (RR: 0.54). At the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts with a higher proportion below the poverty level (POR: 0.81) and with a higher proportion of vacant houses (POR: 0.86). In comparison, housing vacancy was positively associated with HIV diagnosis rates among black non-MSM (RR: 1.65). HIV diagnosis rates were higher for black MSM (RR: 2.75) and non-MSM (RR: 4.90) whose educational level was low. Rates were significantly lower for black MSM (RR: 0.06) and non-MSM (RR: 0.26) as the proportion unemployed and the proportion married increased.
  
  
  CONCLUSIONS
  This exploratory study found differences in the patterns of HIV diagnosis rates for black MSM and non-MSM and provides insight into the transmission of HIV infection in areas that reflect substantial disadvantage in education, housing, employment, and income.
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, United States of America.
authors.forename: Zanetta
authors.initials: Z
authors.lastname: Gant
authors.affiliation: School of Social Work, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Larry
authors.initials: L
authors.lastname: Gant
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, United States of America.
authors.forename: Ruiguang
authors.initials: R
authors.lastname: Song
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, United States of America.
authors.forename: Leigh
authors.initials: L
authors.lastname: Willis
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, United States of America.
authors.forename: Anna Satcher
authors.initials: AS
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D019352:Censuses; D062665:Epidemiological Monitoring; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D064890:Social Determinants of Health; D014481:United States / Q000453:epidemiology; D055815:Young Adult