Connecting race and place: A county-level analysis of White, Black, and Hispanic HIV prevalence, poverty, and level of urbanization

A.S. Vaughan, E. Rosenberg, R.L. Shouse and P.S. Sullivan

American Journal of Public Health, 2014, vol. 104, issue 7, e77-e84

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 fromthe year 2009, we constructed negative binomial models, stratified by urbanization,withanoutcomeof 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.

Keywords: African American; ancestry group; article; Caucasian; demography; ethnology; health disparity; Hispanic; human; Human immunodeficiency virus infection; poverty; prevalence; statistics, African Americans; Continental Population Groups; European Continental Ancestry Group; Health Status Disparities; Hispanic Americans; HIV Infections; Humans; Poverty; Prevalence; Residence Characteristics (search for similar items in EconPapers)
Date: 2014
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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2014.301997_5

DOI: 10.2105/AJPH.2014.301997

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