title: State variation in HIV/AIDS health outcomes: the effect of spending on social services and public health.
abstract: OBJECTIVE
  Despite considerable advances in the prevention and treatment of HIV/AIDS, the burden of new infections of HIV and AIDS varies substantially across the country. Previous studies have demonstrated associations between increased healthcare spending and better HIV/AIDS outcomes; however, less is known about the association between spending on social services and public health spending and HIV/AIDS outcomes. We sought to examine the association between state-level spending on social services and public health and HIV/AIDS case rates and AIDS deaths across the United States.
  
  
  METHODS
  We conducted a retrospective, longitudinal study of the 50 U.S. states over 2000-2009 using a dataset of HIV/AIDS case rates and AIDS deaths per 100 000 people matched with a unique dataset of state-level spending on social services and public health per person in poverty.
  
  
  METHODS
  We estimated multivariable regression models for each HIV/AIDS outcome as a function of the social service and public health spending 1 and 5 years earlier in the state, adjusted for the log of state GDP per capita, regional and time fixed effects, Medicaid spending as % of GDP, and socio-demographic, economic, and health resource factors.
  
  
  RESULTS
  States with higher spending on social services and public health per person in poverty had significantly lower HIV and AIDS case rates and fewer AIDS deaths, both 1 and 5 years post expenditure (P ≤ 0.05).
  
  
  CONCLUSIONS
  Our findings suggest that spending on social services and public health may provide a leverage point for state policymakers to reduce HIV/AIDS case rates and AIDS deaths in their state.
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Talbert-Slagle
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Canavan
authors.forename: Erika M
authors.initials: EM
authors.lastname: Rogan
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality* / Q000517:prevention & control; D005102:Health Expenditures; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011634:Public Health / Q000191:economics*; D012189:Retrospective Studies; D012947:Social Work / Q000191:economics*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology