Social Determinants of Health and HIV Diagnosis Rates in U.S. Counties, Comparing Ending the Epidemic (EHE) and Non-EHE Priority Jurisdictions.

Abstract

In the U.S., HIV diagnoses have remained steady over the past decade - despite the availability of condoms and pre-exposure prophylaxis. Factors such as adverse Social Determinants of Health (SDoH) may contribute to the sustained HIV diagnosis rate. This study sought to identify SDoH factors associated with HIV diagnosis rates in U.S. counties and between Ending the Epidemic (EHE) priority jurisdictions and non-EHE jurisdictions. We obtained county-level data from publicly available sources. We fit Poisson regression models to estimate associations between separate county-level SDoH factors and county-level HIV diagnosis rates among 344 U.S. counties and 82 EHE priority jurisdictions. Among all U.S. counties, five factors were associated with HIV diagnosis rates. In all U.S. counties, higher percent of renter-occupied housing with rent at least 30% of household income, percent of population with no health insurance, presence of medically underserved area, and percent of housing units that are overcrowded were associated with HIV diagnosis rates. For three factors (percent of populations with less than a high school education, Index of Dissimilarity, and number of social organizations), associations with HIV diagnosis rates were significantly different between non-EHE and EHE priority jurisdictions. Future research should examine SDoH drivers of HIV diagnoses, including how they impact HIV prevention efforts. Long term, these efforts can help develop novel interventions to reduce HIV transmission.