Racial and socioeconomic disparities in viral suppression among persons living with HIV in New York City

Xia, Qiang; Robbins, Rebekkah S.; Lazar, Rachael; Torian, Lucia V.; Braunstein, Sarah L.

doi:10.1016/j.annepidem.2017.04.005

Cited by 25 publications

(30 citation statements)

References 35 publications

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“…Our finding is inconsistent with one study of New York City surveillance data which suggested that while neighborhood poverty was not associated with achieving viral suppression, it was associated with lower likelihood of maintaining viral suppression after diagnosis [33]. However, the literature on the effect of neighborhoods on viral suppression is mixed with some studies showing an association between residing in areas of high deprivation and poor viral suppression [34,35], and others showing no association [36,37]. It is possible that neighborhood units smaller than the ZIP code or other neighborhood characteristics not measured in this study, particularly perceptions of one's neighborhood, may be important.…”

Section: Discussioncontrasting

confidence: 99%

“…Characteristics of men who have sex with men by sustained viral load suppression, 2017 (n = 3386) Characteristics of men who have sex with men by sustained viral load suppression, 2017 (n = 3386) (Continued)In the multivariate analyses the odds of sustained viral suppression were lower for younger MSM (18-24 [aOR 0.51, 95% CI 0.34-0.77] and 25-34 [aOR 0.68, 95% CI 0.52-0.87] compared with[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] year-olds) and for Black MSM compared with White MSM (aOR 0.44, 95% CI 0.29-0.69) (Table 2). Individuals not enrolled in the ACA (aOR 0.66, 95% CI 0.48-0.90), currently reporting Characteristics of men who have sex with men by sustained viral load suppression, 2017 (n = 3386) (Continued)…”

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confidence: 99%

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Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

et al. 2020

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Background: HIV viral suppression is associated with health benefits for people living with HIV and a decreased risk of HIV transmission to others. The objective was to identify demographic, psychosocial, provider and neighborhood factors associated with sustained viral suppression among gay, bisexual, and other men who have sex with men. Methods: Data from adult men who have sex with men (MSM) enrolled in the Miami-Dade County Ryan White Program (RWP) before 2017 were used. Sustained viral suppression was defined as having an HIV viral load < 200 copies/ml in all viral load tests in 2017. Three-level (individual, medical case management site, and neighborhood) cross-classified mixed-effect models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for sustained viral suppression. Results: Of 3386 MSM, 90.8% were racial/ethnic minorities, and 84.4% achieved sustained viral suppression. The odds of achieving sustained viral suppression was lower for 18-24 and 25-34 year-old MSM compared with 35-49 year-old MSM, and for non-Latino Black MSM compared with White MSM. Those not enrolled in the Affordable Care Act, and those with current AIDS symptoms and a history of AIDS had lower odds of achieving sustained viral suppression. Psychosocial factors significantly associated with lower odds of sustained viral suppression included drug/alcohol use, mental health symptoms, homelessness, and transportation to appointment needs. Individuals with an HIV physician who serves a larger volume of RWP clients had greater odds of sustained viral suppression. Neighborhood factors were not associated with sustained viral suppression.(Continued on next page)

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Section: Discussioncontrasting

confidence: 99%

mentioning

confidence: 99%

Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

et al. 2020

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“…Population level disparities in retention, access to ART and virological suppression have also been found in other settings, including countries in South‐East and East Asia, where facilities face challenges in providing care for a growing number of PLHIV in resource‐limited settings . However, sex, race as well as other demographic and socioeconomic disparities in HIV care exist even in developed economies . It demonstrates the complexities of chronic care for vulnerable groups disproportionately affected by HIV, and resulting inequities at every step of the care cascade.…”

Section: Discussionmentioning

confidence: 93%

Using a HIV registry to develop accurate estimates for the HIV care cascade – the Singapore experience

Huang

Wong

et al. 2019

J Intern AIDS Soc

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Introduction Achieving UNAIDS 90‐90‐90 targets is a crucial step towards ending the AIDS epidemic. Many countries have published estimates of care cascades, although often with methodological limitations. We describe an approach that used the national HIV registry as a starting‐point to determine the HIV care cascade and resulting UNAIDS 90‐90‐90 estimates for Singapore in 2014. Methods HIV is a legally notifiable disease in Singapore. The anonymized HIV registry data provided for a back‐calculation model from the European Centre for Disease Prevention and Control to obtain 2014 estimates for the total number of persons living with HIV (PLHIV), and the count in the registry for proportions diagnosed with HIV and linked to care. Using additional data collected for a simple random sample from the registry, outcomes in 2015 and 2016 were ascertained retrospectively to derive proportions for those retained in care, on antiretroviral therapy, and achieved viral suppression. Findings were extrapolated to derive national estimates and UN90‐90‐90 estimates. Bootstrapped samples from the model and sample were used to derive 95% confidence intervals. Results An estimated 6900 (95% CI 6650, 7050) persons were living with HIV and AIDS in 2014. Of these, 4948 were diagnosed with HIV, and 4820 had been linked to care. The random sample of 500 persons was further analysed, and of these, 87.2% were retained in care, 84.6% on antiretroviral therapy, and 79.6% had suppressed viral loads. The proportions of HIV‐infected individuals on antiretroviral therapy and achieving viral suppression were 60.7% (95% CI 58.4, 63.6) and 57.1% (95% CI 55.0, 60.5) respectively. The corresponding UNAIDS 90‐90‐90 estimates were 71.7% (95% CI 70.0, 74.2) of all persons diagnosed; 84.6% (95% CI 81.6, 87.4) of diagnosed persons being on antiretroviral therapy, and 94.1% (95% CI 91.6, 96.2) of persons on therapy having achieved viral suppression. Conclusions A national HIV registry, alongside back‐calculation and additional data from a sample, can be used to estimate attainment of UNAIDS 90‐90‐90 targets and identify system gaps. The registry had advantages of providing a well‐established, comprehensive capture of diagnosed persons and easily accessible data. The same approach can be used elsewhere if similar data are available.

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“…Racial/ethnic disparities in HIV incidence, HIV prevalence, engagement along the HIV care continuum, and health outcomes, are signi cant and persistent (5,6). First, the majority of PLWH in the United States are from African American or Black racial and/or Latinx ethic and low socio-economic status (SES) backgrounds, and, thus, over-represented compared to their proportions in the general population (7,8). Moreover, compared to White PLWH, African American/Black and Latinx PLWH evidence longer times between diagnosis with HIV and initiation of HIV antiretroviral therapy (ART) and between ART initiation and achieving HIV viral suppression, the ultimate goal of HIV treatment (9).…”

Section: Causes Of Inequity In Engagement Along the Hiv Care Cascadementioning

confidence: 99%

“…The literature describing the factors that create these disparities along the HIV care continuum highlights a set of interconnected multi-level in uences. First, low SES appears to account for at least some of these observed racial/ethnic disparities in HIV outcomes (8,13). Low SES creates complex competing priorities and tangible structural barriers to engagement, including unstable or low-quality housing (14,15).…”

Section: Causes Of Inequity In Engagement Along the Hiv Care Cascadementioning

confidence: 99%

Understanding long-term HIV survivorship among African American/Black and Latinx persons living with HIV in the United States: A qualitative exploration through the lens of symbolic violence

Freeman

Gwadz

Wilton

et al. 2020

Preprint

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Background Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about successful HIV management over decades. To address this gap, the present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, non-physical violence manifested in the power differential between social groups. We focused on adult African American/Black and Hispanic/Latinx (AABHL) PLWH from low SES-backgrounds. Methods Data were drawn from two studies with AABHL PLWH in New York City ( N =59). After providing signed informed consent, participants engaged in in-depth semi-structured interviews on aspects of HIV management. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using a systematic content analysis approach. Results Participants in the two studies were comparable on sociodemographic and HIV history characteristics. They had lived with HIV for 20 years, on average (range 3-33 years). All were from low-SES backgrounds and most were African American/Black and men. Participants experienced a convergence of multiple intersecting social exclusions, harms, and stigmas, consistent with symbolic violence, which contributed to disengagement from HIV care and medications. We found five specific sub-themes: (1) material, social, and emotional challenges combined to “grind down” participants over time and diminish self-worth and even, at times, the will to live, (2) social isolation and self-isolation, based in part on feeling devalued and dehumanized, served as both a stigma-avoidance strategy and a mechanism of social exclusion, (3) stigmatizing aspects of patient-provider interactions, both experienced and anticipated, and (4) perceived restricted autonomy in HIV care reduced engagement, and (5) poor HIV management was internalized as a personal failure. Importantly, resilience was also evident throughout the five sub-themes. Conclusions Symbolic violence is a useful framework for understanding the experiences of long-term HIV management/survivorship among AABHL PLWH from low-SES backgrounds. Aspects of symbolic violence are internalized over time (e.g., experiencing devaluation, dehumanization, loss of self-worth, and anticipated stigma), thereby impeding successful HIV management, including because avoiding HIV care and discontinuing HIV medications are primary coping strategies. Study findings have implications for interventions in community and health care settings.

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Racial and socioeconomic disparities in viral suppression among persons living with HIV in New York City

Cited by 25 publications

References 35 publications

Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

Using a HIV registry to develop accurate estimates for the HIV care cascade – the Singapore experience

Understanding long-term HIV survivorship among African American/Black and Latinx persons living with HIV in the United States: A qualitative exploration through the lens of symbolic violence

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