title: Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing.
abstract: In the United States, research is limited on the mechanisms that link socioeconomic and structural factors to HIV diagnosis outcomes. We tested whether neighborhood income inequality, socioeconomic deprivation, and black racial concentration were associated with gender-specific rates of HIV in the advanced stages of AIDS (i.e., late HIV diagnosis). We then examined whether HIV testing prevalence and accessibility mediated any of the associations above. Neighborhoods with highest (relative to lowest) black racial concentration had higher relative risk of late HIV diagnosis among men (RR=1.86; 95%CI=1.15, 3.00) and women (RR=5.37; 95%CI=3.16, 10.43) independent of income inequality and socioeconomic deprivation. HIV testing prevalence and accessibility did not significantly mediate the associations above. Research should focus on mechanisms that link black racial concentration to HIV diagnosis outcomes.
authors: Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: yransome@hsph.harvard.edu.
authors: Yusuf
authors: Y
authors: Ransome
authors: Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors: Ichiro
authors: I
authors: Kawachi
authors: New York City Department of Health and Mental Hygiene, New York, NY, USA.
authors: Sarah
authors: S
authors: Braunstein
authors: City University of New York (CUNY) Institute for Implementation Science in Population Health, NY, USA.
authors: Denis
authors: D
authors: Nash
mesh_terms: D001741:Black or African American; D000704:Analysis of Variance; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D040362:Geographic Information Systems; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008297:Male; D009519:New York City / Q000453:epidemiology; D011203:Poverty; D012042:Registries; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States; D014505:Urban Population
keywords: Black racial concentration; HIV testing; Income inequality; Late HIV diagnosis; Socioeconomic deprivation