The role of disparity in “unequal” HIV care

A study examining structural factors in HIV care shows “marked differences” in the socioeconomic environments of black and white patients living with HIV.


“Certain social and structural factors have contributed to blacks accounting for a higher proportion of new HIV infections than other races and ethnicities,” says Joseph Logan, PhD. “To achieve health equity and end the HIV epidemic, the nation must overcome persistent barriers that have contributed to disparities for too long. Understanding the social determinants of health is key to reducing HIV-related health inequalities.

For a study published in AIDS and behaviorthe research team looked at “three structural factors that may influence inequities in HIV care outcomes,” according to Dr. Logan, including racial redlining, Medicaid expansion, and use of the Ryan White program HIV / AIDS.

Investigators used three lines of evidence to examine the association with HIV care within one month of diagnosis and viral suppression (i.e., viral load

“Clear” socioeconomic differences between black and white patients

Compared to white participants, black people had lower rates of linkage to care within one month of HIV diagnosis (82.3% vs. 75.8%) and viral suppression in 2018 (77.3% vs. 67 .8%). No association was found between redlining and HIV outcomes. For both racial/ethnic groups, more people living with HIV who lived in states with Medicaid expansion were linked to HIV care within one month of diagnosis compared to HIV-positive patients who lived in states without Medicaid expansion.

“Structural factors intended to reduce the financial burden of HIV care and improve access were positively associated with being linked to HIV care within one month of diagnosis and achieving viral suppression for black people and white people living with HIV,” says Dr. Logan.

The study results showed “marked differences” within the socio-economic environments in which black and white patients living with HIV reside, according to Dr Logan. (Table).

“We did not see a positive association between residing in a state with Medicaid expansion and achieving viral suppression compared to residing in a state without Medicaid expansion,” he says. “The strongest structural factor positively associated with viral suppression was residing in a state where more than 50% of people living with HIV received Ryan White HIV/AIDS program services.

Increase services for patients and conduct additional research

The researchers note that to their knowledge, this study is the first to simultaneously analyze redlining, Medicaid expansion, and use of the Ryan White HIV/AIDS program in association with HIV care outcomes for black and whites in the United States. The results show that black and white people living with HIV live in “very different socio-economic environments, which could create unequal challenges related to receiving ongoing HIV care,” says Dr. Logan.

“Policies and programs that aim to reduce the financial burden of HIV care, such as Medicaid expansion and the Ryan White HIV/AIDS program, show promise for achieving favorable HIV care outcomes,” he continues. . “However, while Medicaid expansion was positively associated with connecting people to HIV care within one month of diagnosis, this program was not associated with obtaining a viral suppression for our study population.”

Increasing the use of services available through the Ryan White program, such as referrals to housing, transportation, mental health and addictions services, could help reach the groups most affected by the who are also struggling financially, says Dr. Logan.

“Redlining was not definitively associated with HIV outcomes in this study,” he says. “However, more work is needed to determine whether redlining perpetuates circumstances such as poverty, which in turn could increase the risk of contracting HIV or hinder the ability to sustain care. Nearly two-thirds of black people diagnosed with HIV resided in census tracts where black loan applicants were at least twice as likely to be rejected for a home loan as white applicants, even after controlling for the applicant’s sex at birth, income annual gross, and loan amount Not being able to build wealth or financial stability through home ownership while needing ongoing HIV care could perpetuate ongoing financial disadvantage.

Future research should address these disparities in other minority groups, Dr. Logan notes.

“This study focused on disparities in HIV care between blacks and whites,” he says. “Future research is needed to assess factors related to inequities and disparities in HIV care between whites and other racial and ethnic minority groups who have traditionally been disadvantaged in terms of obtaining health care. .”

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