Race, Inequality, and HIV Disease Distribution: A Study of U.S. National Trends from 2010 -2016

Background: HIV prevention in the United States has shifted to an ambitious agenda centered on eliminating new HIV infections and reducing health disparities across all groups to increase access to quality HIV care in the United States. The complicated interplay of poverty, health disparities, and repeated risk exposure serve as drivers of the HIV epidemic for black Americans and the communities in which they live. Further research is needed to better understand how poverty and to a larger extent income inequality may influence HIV disease burden among specific racial and ethnic groups.

Methods: County-level measures were sourced from national population-based surveys and surveillance data comprised in annual American Community Surveys, U.S. Crime Data Statistics, U.S. Population Estimates, HIV Surveillance Reports. Analysis focused on 196 counties representing 28 distinct states across the United States from 2010-2016. Group means of HIV incidence rates (outcome), the main effects (race and income inequality), and covariates (crime rate, unemployment rate, and educational attainment) were determined to explore fluctuations in risk environments that may have changed from year to year. This was followed by a temporal trend analysis to test significance of any changes. Bivariate analysis was then conducted to evaluate the empirical relationship between race, income inequality and HIV incidence rates in relation to key aspects of the risk environment (covariates).

Results: Temporal trend analysis demonstrates an association between the layered effects of income inequality and racial disparities on HIV incidence rates despite national trends of declining HIV rates in the United States. Results indicate a significant reduction in HIV incidence rates across several years (2013 [R ² = .345, t =-2.11, p <.05]; 2015 [t = -2.34, p <.05]; 2016 [t = -2.67, p <.01]). However, both Blacks and Latinos continued to observe significant increases in HIV incidence rates within their communities with Black Americans having the largest growth [t = 6.34, p <.001]. Also, there were notably rises in income inequality despite what seemed to be fairly stable national rates from 2010-2016 [t = 2.79, p <.01]. Income inequality in the community was linked to elevated HIV incidence rates [r = .24, t= 9.31, p<.001], which was also indicative of the presence of higher rates of violent crime in the community [r = .36, t = 14.23, p <.001]. Counties with higher proportions of Blacks are positively associated with high rates of income inequality [r = .23, t = 8.67, p<.001] and also higher violent crime rates [r = .37, t=14.85, p <.001].

Conclusions: Despite what we have seen as marked gains in the area of HIV prevention, the findings evidenced in this paper highlight racial and ethnic disparities that are inextricably linked to the inequality communities of color are confronted with on a regular basis. This analysis not only highlights that race and inequality are significantly associated with HIV incidence rates, but even more to the point, there is a notable interplay between race an inequality in the risk environment that predispose Blacks and Latinos to higher rates of HIV.