Social Determinants of Health Affect Ability to Control HIV

Among people with human immunodeficiency virus (HIV) in San Francisco, worse community-level social determinants of health (SDH) metrics were associated with uncontrolled HIV. Researchers published their findings in Open Forum Infectious Diseases.

“This study observed people with HIV residing in census tracts with worse SDH metric measures and those experiencing homelessness are especially vulnerable,” wrote lead and corresponding author Jason S. Melo, MPH, of the San Francisco Department of Public Health, and coauthors. “Innovative programs to engage people with HIV living in these marginalized neighborhoods and people experiencing homelessness are needed.”

Some 7486 adults with HIV who had been prescribed antiretroviral therapy were included in the study. Researchers derived local SDH metrics using American Community Survey data with a focus on five areas: (1) percentage of residents below the federal poverty level; (2) percentage of residents with less than a high school diploma; (3) percentage of uninsured residents; (4) median household income; and (5) a measure of income inequality called the Gini index.

Among people in the study population, 6889 had controlled HIV and 597 had uncontrolled HIV.

For all metrics, unadjusted prevalence odds for uncontrolled HIV rose with increasingly marginalized quartiles compared with the least marginalized quartile, according to the study. After adjustment for demographics and transmission category, prevalence odds ratios for uncontrolled HIV for people in the most marginalized quartile were 2.0 for poverty, 2.4 for education, 1.8 for insurance, 1.8 for income, and 1.5 for income inequality.

A sensitivity analysis that included homeless people with HIV yielded similar findings, researchers reported.

“In addition to established care programs, people with HIV experiencing socioeconomic marginalization require support and innovative interventions to achieve health outcome goals,” the authors advised. “By focusing on the health needs of vulnerable subpopulations, coupled with tailored programs and policies, we can create pathways to good health, reduce health inequities, and progress toward zero new HIV infections and ending the HIV epidemic.”

Reference: 
Melo JS, Hessol NA, Pipkin S, Buchbinder SP, Hsu LC. Effect of social determinants of health on uncontrolled human immunodeficiency virus (HIV) infection among persons with HIV in San Francisco, California. Open Forum Infect Dis. 2022;9(7):ofac312. doi:10.1093/ofid/ofac312