A County-Level Examination of the Relationship Between HIV and Social Determinants of Health: 40 States, 2006-2008.

Background: Social determinants of health (SDH) are the social and physical factors that can influence unhealthy or risky behavior. Social determinants of health can affect the chances of acquiring an infectious disease - such as HIV - through behavioral influences and limited preventative and healthcare access. We analyzed the relationship between social determinants of health and HIV diagnosis rates to better understand the disparity in rates between different populations in the United States.

Methods: Using National HIV Surveillance data and American Community Survey data at the county level, we examined the relationships between social determinants of health variables (e.g., proportion of whites, income inequality) and HIV diagnosis rates (averaged for 2006-2008) among adults and adolescents from 40 states with mature name-based HIV surveillance.

Results: Analysis of data from 1,560 counties showed a significant, positive correlation between HIV diagnosis rates and income inequality (Pearson correlation coefficient ρ = 0.40) and proportion unmarried - ages >15 (ρ = 0.52). There was a significant, negative correlation between proportion of whites and rates (ρ = -0.67). Correlations were low between racespecific social determinants of health indicators and rates.

Conclusions/implications: Overall, HIV diagnosis rates increased as income inequality and the proportion unmarried increased, and rates decreased as proportion of whites increased. The data reflect the higher HIV prevalence among non-whites. Although statistical correlations were moderate, identifying and understanding these social determinants of health variables can help target prevention efforts to aid in reducing HIV diagnosis rates. Future analyses need to determine whether the higher proportion of singles reflects higher populations of gay and bisexual men.