Systemic racism is associated with new HIV diagnoses in all regions of the United States except the Midwest, researchers report.
Social determinants of health and systemic racism are known drivers of health inequities, but how they affect Variables included in the final model were age group among men, race or ethnicity, poverty, not graduating from high school, lack of insurance coverage, and measures of residential segregation—including the Gini coefficient, the Delta index, and the Spatial Proximity Index. The study team determined that HIV acquisition in various regions of the United States has not been adequately investigated.
To explore this relationship across five US regions, the authors used publicly available 2013−2021 data from the AIDSVu interactive online HIV prevalence map and from the American Community Survey (ACS) ongoing survey of population and housing data. They merged these two tools using the county-level Federal Information Processing System (FIPS) codes, which identify geographic entities in the US.
The researchers extracted county-level data and then aggregated the data to the regional level. They ran a generalized estimation equation model within each region to explore the associations between the social determinants of health, systemic racism, and new HIV diagnoses over time.
Of the 3,013 US counties included in the analysis, 712 were in the Deep South, 636 in the South, 237 in the North, 398 in the West, and 1,030 in the Midwest.
Prior to the COVID-19 pandemic, new HIV diagnoses at the county level were highest in the Deep South, declining in the North and South, and rising in the West. New diagnoses declined in all regions in 2019 and 2020 due to service interruptions, but began rising in 2021, approaching pre-pandemic levels.
By region, counties with a higher proportion of men aged 35−54 (Deep South: incident rate ratio (IRR) = 1.07, West: 1.06, Midwest: 1.14, North: 0.96; P≤0.05) and Black populations (Deep South: 1.45, South: 1.46, North: 1.17, West: 1.49, Midwest: 2.62; P≤0.001) tended to have higher rates of new HIV diagnoses.
Systemic racism was positively associated with new HIV diagnoses in all regions of the country except the Midwest. The researchers identified two interaction terms: Black × delta (Deep South: 1.05, West: 1.28, North: 0.92; P≤0.01) and poverty × Gini (Deep South: 0.91, South: 0.89, Midwest: 0.65, North: 1.08; P≤0.001).
Reference
Garrett C, et al. IAS 2025. Program number OAD0205.
