Connecting Race and Place: a County-level Analysis of White, Black, and Hispanic HIV Prevalence, Poverty, and Level of Urbanization

Overview

Journal Am J Public Health

Specialty Public Health

Date 2014 May 17

PMID 24832420

Citations 34

Authors

Adam S Vaughan

Eli Rosenberg

R Luke Shouse

Patrick S Sullivan

Affiliations

Soon will be listed here.

Abstract

Objectives: We evaluated the role of poverty in racial/ethnic disparities in HIV prevalence across levels of urbanization.

Methods: Using national HIV surveillance data from the year 2009, we constructed negative binomial models, stratified by urbanization, with an outcome of race-specific, county-level HIV prevalence rates and covariates of race/ethnicity, poverty, and other publicly available data. We estimated model-based Black-White and Hispanic-White prevalence rate ratios (PRRs) across levels of urbanization and poverty.

Results: We observed racial/ethnic disparities for all strata of urbanization across 1111 included counties. Poverty was associated with HIV prevalence only in major metropolitan counties. At the same level of urbanization, Black-White and Hispanic-White PRRs were not statistically different from 1.0 at high poverty rates (Black-White PRR = 1.0, 95% confidence interval [CI] = 0.4, 2.9; Hispanic-White PRR = 0.4, 95% CI = 0.1, 1.6). In nonurban counties, racial/ethnic disparities remained after we controlled for poverty.

Conclusions: The association between HIV prevalence and poverty varies by level of urbanization. HIV prevention interventions should be tailored to this understanding. Reducing racial/ethnic disparities will require multifactorial interventions linking social factors with sexual networks and individual risks.

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