Non-Linkage to Care and Non-Viral Suppression among Hispanic/Latino Persons by Birthplace and Social Vulnerability-United States, 2021.

BACKGROUND: Assessing individual- and community-level factors may help to explain differences among Hispanic/Latino adults with diagnosed HIV not linked to care and without viral suppression in the United States. METHODS: We analyzed CDC's National HIV Surveillance System data among Hispanic/Latino persons aged ≥ 18 years with HIV diagnosed during 2021 in 47 states and the District of Columbia and linked cases via census tracts to the CDC/ATSDR's Social Vulnerability Index (SVI). Adjusted prevalence ratios and 95% confidence intervals for non-linkage to care and non-viral suppression were estimated using Poisson regression model. RESULTS: Among 5,056 Hispanic/Latino adults with HIV diagnosed in 2021, 51.5% were born in the United States, 17.3% in Mexico, 9.2% in Central America, 11.1% in South America, 1.8% in Puerto Rico, 6.8% in Cuba, and 2.4% in the Caribbean. Compared with U.S.-born Hispanic/Latino adults, those born in Mexico and South America had a lower prevalence of non-linkage to care. Hispanic/Latino adults born in Mexico, South America, and the Caribbean (excluding Puerto Rico and Cuba) had a lower prevalence of non-viral suppression, compared with those born in the United States. No significant differences were observed among SVI quartiles for either care outcome. CONCLUSION: This study aimed to challenge the narrow perspective on HIV care outcomes by examining the impact of birthplace and social vulnerability among Hispanic/Latino adults. To increase HIV care and prevention among Hispanic/Latino persons, research must evaluate health disparities within the group, and efforts are needed to better understand and tailor interventions within the diverse Hispanic/Latino population.

CDC Prioritizes HIV Prevention and Treatment to Reduce HIV Disparities Among Cis-Gender Black Women.

To succeed in ending the HIV epidemic in the United States, the Centers for Disease Control and Prevention (CDC) focuses on delivering combinations of scientifically proven, cost-effective, and scalable interventions to priority populations. Systemic factors continue to contribute to persistent health disparities and disproportionately higher rates of HIV diagnosis in some communities. The National HIV/AIDS Strategy has designated cis-gender Black women (CgBW) as a priority population to address the racial and ethnic inequities in HIV. This report presents the portfolio of projects, programs, and initiatives funded by the CDC's Division of HIV Prevention (DHP) to address disparities in HIV and improve health and QOL among CgBW. These funded activities include the development, planning, and implementation of HIV prevention programs, mass media campaigns, and behavioral interventions focused on CgBW. This report also summarizes DHP's community engagement, capacity building, and partnership efforts, and highlights research and surveillance activities focusing on CgBW. Finally, this report outlines future directions for CDC's efforts to improve access to HIV testing, treatment, and prevention for CgBW in the United States.

Using the Index of Concentration at the Extremes to Evaluate Associations of Economic and Hispanic/Latino-White Racial Segregation with HIV Outcomes Among Adults Aged ≥ 18 Years with Diagnosed HIV - United States, 2021.

OBJECTIVE(S): To examine associations between Index of Concentration at the Extremes (ICE) measures (proxy for structural racism) for economic and Hispanic/Latino-White racial segregation and HIV outcomes among adults in the U.S. METHODS: Census tract-level HIV diagnoses, linkage to HIV medical care within 1 month of diagnosis (linkage), and viral suppression within 6 months of diagnosis (viral suppression) data for 2021 from the National HIV Surveillance System were used. Three ICE measures were obtained from the American Community Survey: ICEincome (income segregation), ICErace (Hispanic/Latino-White racial segregation), and ICEincome + race (Hispanic/Latino-White racialized economic segregation). Rate ratios (RRs) for HIV diagnosis and prevalence ratios (PRs) for linkage and viral suppression were used to examine differences in HIV outcomes across ICE quintiles with Quintile5 (Q5: most privileged) as reference group and adjusted by selected characteristics. RESULTS: Among the 32,529 adults, diagnosis rates were highest in Quintile1 (Q1: most deprived) for ICEincome (28.7) and ICEincome + race (28.4) and Q2 for ICErace (27.0). We also observed higher RRs in HIV diagnosis and lower PRs in linkage and viral suppression (except for ICErace for linkage) in Q1 compared to Q5. Higher RRs and lower PRs in ICE measures were observed among males (diagnosis), adults aged 18‒34 (diagnosis and linkage) and aged ≥ 45 (viral suppression), and among adults in the South (all 3 HIV outcomes). CONCLUSIONS: Barriers in access to care/treatment in more Hispanic/Latino-White racialized economic segregated communities perpetuate the disproportionate impact of HIV on the population. Removing barriers to HIV care/treatment created by systemic racism/segregation may improve HIV outcomes and reduce disparities.

The associations of income and Black-White racial segregation with HIV outcomes among adults aged ≥18 years-United States and Puerto Rico, 2019.

OBJECTIVE(S): To examine associations between Index of Concentration at the Extremes (ICE) measures for economic and racial segregation and HIV outcomes in the United States (U.S.) and Puerto Rico. METHODS: County-level HIV testing data from CDC's National HIV Prevention Program Monitoring and Evaluation and census tract-level HIV diagnoses, linkage to HIV medical care, and viral suppression data from the National HIV Surveillance System were used. Three ICE measures of spatial polarization were obtained from the U.S. Census Bureau's American Community Survey: ICEincome (income segregation), ICErace (Black-White racial segregation), and ICEincome+race (Black-White racialized economic segregation). Rate ratios (RRs) for HIV diagnoses and prevalence ratios (PRs) for HIV testing, linkage to care within 1 month of diagnosis, and viral suppression within 6 months of diagnosis were estimated with 95% confidence intervals (CIs) to examine changes across ICE quintiles using the most privileged communities (Quintile 5, Q5) as the reference group. RESULTS: PRs and RRs showed a higher likelihood of testing and adverse HIV outcomes among persons residing in Q1 (least privileged) communities compared with Q5 (most privileged) across ICE measures. For HIV testing percentages and diagnosis rates, across quintiles, PRs and RRs were consistently greatest for ICErace. For linkage to care and viral suppression, PRs were consistently lower for ICEincome+race. CONCLUSIONS: We found that poor HIV outcomes and disparities were associated with income, racial, and economic segregation as measured by ICE. These ICE measures contribute to poor HIV outcomes and disparities by unfairly concentrating certain groups (i.e., Black persons) in highly segregated and deprived communities that experience a lack of access to quality, affordable health care. Expanded efforts are needed to address the social/economic barriers that impede access to HIV care among Black persons. Increased partnerships between government agencies and the private sector are needed to change policies that promote and sustain racial and income segregation.

Trends in HIV care outcomes among adults and adolescents in the U.S. South, 2015-2019.

PURPOSE: HIV disparities continue to persist in the southern United States and among some populations. Early HIV diagnosis, prompt linkage to care, and viral suppression among persons with HIV in the South, in particular the Deep South, are critical to reduce disparities and achieve national prevention goals. METHODS: Estimated annual percent changes were calculated to assess trends during 2015-2019 in percentage distributions for stage of disease at the time of diagnosis, linkage to HIV medical care, and viral suppression. RESULTS: Among 95,488 persons with HIV diagnosed in the South (Deep South: 81,848; Other South:13,640), the overall percentage that received a diagnosis classified as stage 0 increased 9.0%, stages 1-2 increased 1.8%, linkage to HIV care increased 2.9%, and viral suppression increased 5.9%. Changes in care outcomes among American Indian/Alaska Native persons and persons with infection attributed to injection drug use were minimal. CONCLUSIONS: To reach the goals of Ending the HIV Epidemic (EHE) and other federal initiatives, efforts need to focus on prevention and care among persons residing in the South. Addressing factors such as stigma and discrimination and elimination of barriers to HIV testing, care, and treatment are needed to effectively address these disparities in HIV-related care outcomes.

Association Between Social Vulnerability and Rates of HIV Diagnoses Among Black Adults, by Selected Characteristics and Region of Residence - United States, 2018.

During 2018, Black or African American (Black) persons accounted for 43% of all new diagnoses of HIV infection in the United States (1). The annual diagnosis rate (39.2 per 100,000 persons) among Black persons was four times the rate among all other racial/ethnic groups combined, indicating a profound disparity in HIV diagnoses (1,2). Community-level social and structural factors, such as social vulnerability, might help explain the higher rate of HIV diagnoses among Black persons. Social vulnerability refers to the potential negative health effects on communities caused by external stresses (3). CDC used National HIV Surveillance System (NHSS)* and Social Vulnerability Index (SVI)† data to examine the association between diagnosed HIV infections and social vulnerability among Black adults aged ≥18 years. Black adults in communities in the highest quartile of SVI were 1.5 times (rate ratio [RR] = 1.5; 95% CI = 1.4-1.6) as likely to receive a diagnosis of HIV infection as were those in communities in the lowest quartile. Because of a history of racial discrimination and residential segregation, some Black persons in the United States reside in communities with the highest social vulnerability (4,5), and this finding is associated with experiencing increased risk for HIV infection. The development and prioritization of interventions that address social determinants of health (i.e., the conditions in which persons are born, grow, live, work, and age), are critical to address the higher risk for HIV infection among Black adults living in communities with high levels of social vulnerability. Such interventions might help prevent HIV transmission and reduce disparities among Black adults.

Geographic Differences and Social Determinants of Health Among People With HIV Attributed to Injection Drug Use, United States, 2017.

OBJECTIVE: People who inject drugs are among the groups most vulnerable to HIV infection. The objective of this study was to describe differences in the geographic distribution of HIV diagnoses and social determinants of health (SDH) among people who inject drugs (PWID) who received an HIV diagnosis in 2017. METHODS: We used data from the National HIV Surveillance System (NHSS) to determine the counts and percentages of PWID aged ≥18 with HIV diagnosed in 2017. We combined these data with data from the US Census Bureau's American Community Survey at the census tract level to examine regional, racial/ethnic, and population-area-of-residence differences in poverty status, education level, income level, employment status, and health insurance coverage. RESULTS: We observed patterns of disparity in HIV diagnosis counts and SDH among the 2666 PWID with a residential address linked to a census tract, such that counts of HIV diagnosis increased as SDH outcomes became worse. The greatest proportion of PWID lived in census tracts where ≥19% of the residents lived below the federal poverty level, ≥18% of the residents had

A Census Tract-Level Examination of Differences in Social Determinants of Health Among People With HIV, by Race/Ethnicity and Geography, United States and Puerto Rico, 2017.

OBJECTIVE: Social and structural factors, referred to as social determinants of health (SDH), create pathways or barriers to equitable sexual health, and information on these factors can provide critical insight into rates of diseases such as HIV. Our objectives were to describe and identify differences, by race/ethnicity and geography, in SDH among adults with HIV. METHODS: We conducted an ecological study to explore SDH among people with HIV diagnosed in 2017, by race/ethnicity and geography, at the census-tract level in the United States and Puerto Rico. We defined the least favorable SDH as the following: low income (<$40 000 in median annual household income), low levels of education (≥18% of residents have

Geographic Differences in Social Determinants of Health Among US-Born and Non-US-Born Hispanic/Latino Adults With Diagnosed HIV Infection, United States and Puerto Rico, 2017.

OBJECTIVE: HIV disproportionately affects Hispanic/Latino people in the United States, and factors other than individual attributes may be contributing to these differences. We examined differences in the distribution of HIV diagnosis and social determinants of health (SDH) among US-born and non-US-born Hispanic/Latino adults in the United States and Puerto Rico. METHODS: We used data reported to the Centers for Disease Control and Prevention's National HIV Surveillance System (NHSS) to determine US census tract-level HIV diagnosis rates and percentages among US-born and non-US-born Hispanic/Latino adults aged ≥18 for 2017. We merged data from the US Census Bureau's American Community Survey with NHSS data to examine regional differences in federal poverty level, education, median household income, employment, and health insurance coverage among 8648 US-born (n = 3328) and non-US-born (n = 5320) Hispanic/Latino adults. RESULTS: A comparison of US-born and non-US-born men by region showed similar distributions of HIV diagnoses. The largest percentages occurred in census tracts where ≥19% of residents lived below the federal poverty level, ≥18% did not finish high school, the median household income was <$40 000 per year, ≥6% were unemployed, and ≥16% did not have health insurance. A comparison of US-born and non-US-born women by region showed similar distributions. CONCLUSION: The findings of higher numbers of HIV diagnoses among non-US-born Hispanic/Latino adults than among US-born Hispanic/Latino adults, regional similarities in patterns of SDH and HIV percentages and rates, and Hispanic/Latino adults faring poorly in each SDH category are important for understanding SDH barriers that may be affecting Hispanic/Latino adults with HIV in the United States.