目标:研究美国成年人中经济和西班牙裔/拉丁裔-白人种族隔离与艾滋病毒结果的极端集中指数(ICE)措施(结构性种族主义的代理)之间的关联
方法:人口普查级别的艾滋病毒诊断,在诊断后1个月内与艾滋病毒医疗联系(联系),使用来自国家HIV监测系统的2021年诊断后6个月内的病毒抑制(病毒抑制)数据。从美国社区调查中获得了三项ICE措施:ICE收入(收入隔离),ICErace(西班牙裔/拉丁裔-白人种族隔离),和ICE收入+种族(西班牙裔/拉丁裔-白人种族化的经济隔离)。使用HIV诊断的比率(RR)以及连锁和病毒抑制的患病率(PR)来检查ICE五分位数之间HIV结局的差异,以Quintile5(Q5:最特权)为参照组,并根据选定的特征进行调整。
结果:在32,529名成年人中,ICE收入(28.7)和ICE收入+种族(28.4)的Quintile1(Q1:最贫困)诊断率最高,ICErace(27.0)的Q2诊断率最高.我们还观察到,与Q5相比,Q1中HIV诊断中的RR较高,连锁和病毒抑制中的PR较低(ICErace连锁除外)。在男性(诊断)中观察到ICE测量中较高的RR和较低的PR,18-34岁(诊断和联系)和≥45岁(病毒抑制)的成年人,以及南方的成年人(所有3个艾滋病毒结果)。
结论:在更多西班牙裔/拉丁裔-白人种族化的经济隔离社区中,获得护理/治疗的障碍使艾滋病毒对人口的不成比例的影响长期存在。消除系统性种族主义/隔离造成的艾滋病毒护理/治疗障碍可能会改善艾滋病毒的结果并减少差距。
OBJECTIVE: To examine associations between Index of Concentration at the Extremes (ICE) measures (proxy for structural racism) for economic and Hispanic/Latino-White racial
segregation and HIV outcomes among adults in the U.S.
METHODS: Census tract-level HIV diagnoses, linkage to HIV medical care within 1 month of diagnosis (linkage), and viral suppression within 6 months of diagnosis (viral suppression) data for 2021 from the National HIV Surveillance System were used. Three ICE measures were obtained from the American Community Survey: ICEincome (income
segregation), ICErace (Hispanic/Latino-White racial
segregation), and ICEincome + race (Hispanic/Latino-White racialized economic
segregation). Rate ratios (RRs) for HIV diagnosis and prevalence ratios (PRs) for linkage and viral suppression were used to examine differences in HIV outcomes across ICE quintiles with Quintile5 (Q5: most privileged) as reference group and adjusted by selected characteristics.
RESULTS: Among the 32,529 adults, diagnosis rates were highest in Quintile1 (Q1: most deprived) for ICEincome (28.7) and ICEincome + race (28.4) and Q2 for ICErace (27.0). We also observed higher RRs in HIV diagnosis and lower PRs in linkage and viral suppression (except for ICErace for linkage) in Q1 compared to Q5. Higher RRs and lower PRs in ICE measures were observed among males (diagnosis), adults aged 18‒34 (diagnosis and linkage) and aged ≥ 45 (viral suppression), and among adults in the South (all 3 HIV outcomes).
CONCLUSIONS: Barriers in access to care/treatment in more Hispanic/Latino-White racialized economic segregated communities perpetuate the disproportionate impact of HIV on the population. Removing barriers to HIV care/treatment created by systemic racism/
segregation may improve HIV outcomes and reduce disparities.