Connecting Race, Place and HIV Prevalence: A County-Level Analysis Open Access

Abstract

Connecting Race, Place and HIV Prevalence: A County-Level Analysis

Background: Within the United States, disparities in HIV prevalence among the three major
racial/ethnic groups (white, blacks and Hispanics) are striking. The pattern of disparities,
with blacks and whites at the extremes and Hispanics in the middle, extends across risk
groups and geographies. In an attempt to explain these disparities, recent analyses have
found statistically identical HIV prevalence rates among heterosexuals in urban settings
when races live under the same impoverished conditions.

Objective: This analysis aimed to use publicly available data to further explore associations
between poverty, race and HIV in the United States.

Methods: We used national HIV surveillance data and other publicly available data to
examine the interaction between race and poverty on county level HIV prevalence by
urbanization. A negative binomial model, stratified on urbanization, was constructed with
race-specific county-level HIV prevalence rate as the outcome and race, poverty and other
social determinants of health as covariates. Prevalence rate ratios (PRR) were calculated for
black and Hispanic populations, relative to white populations, at each level of urbanization
and for various levels of poverty.

Results: The results indicated that poverty is associated with HIV prevalence only in major
metropolitan areas. In non-urban areas, poverty was not associated with HIV prevalence.
High levels of poverty eliminated or attenuated racial/ethnic disparities only in counties
belonging to major metropolitan areas. Additionally, the relationship between HIV
prevalence and poverty varied by race, with blacks having a stronger association that either
whites or Hispanics.

Discussion: High poverty may explain HIV prevalence rate disparities in major metropolitan counties.
However, outside of these counties, other factors, including sexual networks, must be
examined to explain racial/ethnic rate disparities. These results indicate that future HIV
prevention efforts must consider both location and race.

Table of Contents

TABLE OF CONTENTS

INTRODUCTION 1
METHODS 4
RESULTS 7
Model selection 7
Model results 8
DISCUSSION 11
Limitations 14
Future Directions 16
CONCLUSION 18
REFERENCES 19
TABLES AND FIGURES 23
APPENDIX A: SAS CODE 33

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	HIV poverty disparities urbanization
Committee Chair / Thesis Advisor	Sullivan, Patrick S, Emory University
Committee Members	Shouse, R. Luke, CDC
Partnering Agencies	CDC

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