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Connecting Race, Place and HIV Prevalence: A County-Level Analysis

Vaughan, Adam Stephen (2012)
Master's Thesis (72 pages)
Committee Chair / Thesis Adviser: Sullivan, Patrick S
Committee Members: Shouse, R. Luke (CDC);
Research Fields: Health Sciences, Epidemiology
Partnering Agencies: CDC
Keywords: HIV; poverty; urbanization; disparities
Program: Rollins School of Public Health, Epidemiology (Global Epidemiology)
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Connecting Race, Place and HIV Prevalence: A County-Level Analysis Background: Within the United States, disparities in HIV prevalence among the three major racial/ethnic groups (white, blacks and Hispanics) are striking. The pattern of disparities, with blacks and whites at the extremes and Hispanics in the middle, extends across risk groups and geographies. In an attempt to explain these disparities, recent analyses have found statistically identical HIV prevalence rates among heterosexuals in urban settings when races live under the same impoverished conditions. Objective: This analysis aimed to use publicly available data to further explore associations between poverty, race and HIV in the United States. Methods: We used national HIV surveillance data and other publicly available data to examine the interaction between race and poverty on county level HIV prevalence by urbanization. A negative binomial model, stratified on urbanization, was constructed with race-specific county-level HIV prevalence rate as the outcome and race, poverty and other social determinants of health as covariates. Prevalence rate ratios (PRR) were calculated for black and Hispanic populations, relative to white populations, at each level of urbanization and for various levels of poverty. Results: The results indicated that poverty is associated with HIV prevalence only in major metropolitan areas. In non-urban areas, poverty was not associated with HIV prevalence. High levels of poverty eliminated or attenuated racial/ethnic disparities only in counties belonging to major metropolitan areas. Additionally, the relationship between HIV prevalence and poverty varied by race, with blacks having a stronger association that either whites or Hispanics. Discussion: High poverty may explain HIV prevalence rate disparities in major metropolitan counties. However, outside of these counties, other factors, including sexual networks, must be examined to explain racial/ethnic rate disparities. These results indicate that future HIV prevention efforts must consider both location and race.

Table of Contents

TABLE OF CONTENTS -- INTRODUCTION 1 -- METHODS 4 -- RESULTS 7 -- Model selection 7 -- Model results 8 -- DISCUSSION 11 -- Limitations 14 -- Future Directions 16 -- CONCLUSION 18 -- REFERENCES 19 -- TABLES AND FIGURES 23 -- APPENDIX A: SAS CODE 33


application/pdf Vaughan_Thesis 72 pages (551.4 KB) []
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