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A Census Tract–Level Examination of Social Determinants of Health among Black/African American Men with Diagnosed HIV Infection, 2005–2009—17 US Areas

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  • Zanetta Gant
  • Larry Gant
  • Ruiguang Song
  • Leigh Willis
  • Anna Satcher Johnson

Abstract

Background: HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men (collectively referred to as MSM). A better understanding of the social conditions in which black men live and work may better explain why HIV incidence and diagnosis rates are higher than expected in this population. Methods: Using data from the National HIV Surveillance System and the US Census Bureau's American Community Survey, we examined the relationships of HIV diagnosis rates and 5 census tract–level social determinants of health variables for 21,948 black MSM and non-MSM aged ≥15 years residing in 17 areas in the United States. We examined federal poverty status, marital status, education level, employment status, and vacancy status and computed rate ratios (RRs) and prevalence odds ratios (PORs), using logistic regression with zero-inflated negative binomial modeling. Results: Among black MSM, HIV diagnosis rates decreased as poverty increased (RR: 0.54). At the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts with a higher proportion below the poverty level (POR: 0.81) and with a higher proportion of vacant houses (POR: 0.86). In comparison, housing vacancy was positively associated with HIV diagnosis rates among black non-MSM (RR: 1.65). HIV diagnosis rates were higher for black MSM (RR: 2.75) and non-MSM (RR: 4.90) whose educational level was low. Rates were significantly lower for black MSM (RR: 0.06) and non-MSM (RR: 0.26) as the proportion unemployed and the proportion married increased. Conclusions: This exploratory study found differences in the patterns of HIV diagnosis rates for black MSM and non-MSM and provides insight into the transmission of HIV infection in areas that reflect substantial disadvantage in education, housing, employment, and income.

Suggested Citation

  • Zanetta Gant & Larry Gant & Ruiguang Song & Leigh Willis & Anna Satcher Johnson, 2014. "A Census Tract–Level Examination of Social Determinants of Health among Black/African American Men with Diagnosed HIV Infection, 2005–2009—17 US Areas," PLOS ONE, Public Library of Science, vol. 9(9), pages 1-7, September.
    • Handle: RePEc:plo:pone00:0107701
    DOI: 10.1371/journal.pone.0107701
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    References listed on IDEAS

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    1. Millett, G.A. & Peterson, J.L. & Wolitski, R.J. & Stall, R., 2006. "Greater risk for HIV infection of black men who have sex with men: A critical literature review," American Journal of Public Health, American Public Health Association, vol. 96(6), pages 1007-1019.
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    3. Waldron, Ingrid & Hughes, Mary Elizabeth & Brooks, Tracy L., 1996. "Marriage protection and marriage selection--Prospective evidence for reciprocal effects of marital status and health," Social Science & Medicine, Elsevier, vol. 43(1), pages 113-123, July.
    4. Diez-Roux, A.V., 1998. "Bringing context back into epidemiology: Variables and fallacies in multilevel analysis," American Journal of Public Health, American Public Health Association, vol. 88(2), pages 216-222.
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