title: Understanding Cross-Sectional Racial, Ethnic, and Gender Disparities in Antiretroviral Use and Viral Suppression Among HIV Patients in the United States.
abstract: To examine racial/ethnic and gender disparities in antiretroviral (ART) use and viral suppression among HIV-infected persons in care and identify factors that might account for observed disparities. The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States. We used weighted interview and medical record data collected 06/2009 to 05/2012 to estimate the prevalence of ART use and viral suppression among gender-stratified racial/ethnic groups. We used χ² tests to identify significant differences in outcomes between white men versus other groups, and logistic regression models to identify the most parsimonious set of factors that could account for each observed difference. We found no significant disparity in ART use between white and Hispanic men, and no disparities between white men and white and Hispanic women after adjustment for disease stage, age, and poverty. Disparities in ART use between white men and black persons persisted after adjusting for other factors, but the observed differences were relatively small. Differences in ART use and adherence, demographic characteristics, and social determinants of health such as poverty, education, and insurance accounted for the observed disparities in viral suppression between white men and all groups except black men. In our model, accounting for these factors reduced the prevalence difference in viral suppression between white and black men by almost half. We found that factors associated with disparities differed among men and women of the same race/ethnicity, lending support to the assertion that gender affects access to care and health status among HIV-infected patients. In addition to supporting efforts to increase ART use and adherence among persons living with HIV, our analysis provides evidence for the importance of social determinants of health in understanding racial/ethnic and gender differences in ART use and viral suppression.
authors.affiliation: From the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Beer
authors.forename: Christine L
authors.initials: CL
authors.lastname: Mattson
authors.forename: Heather
authors.initials: H
authors.lastname: Bradley
authors.forename: Jacek
authors.initials: J
authors.lastname: Skarbinski
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000208:ethnology; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012737:Sex Factors; D019529:Sexuality; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States; D019562:Viral Load; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents