Identifying Which Place Characteristics are Associated with the Odds of Recent HIV Testing in a Large Sample of People Who Inject Drugs in 19 US Metropolitan Areas

Abstract

This exploratory analysis investigates relationships of place characteristics to HIV testing among people who inject drugs (PWID). We used CDC's 2012 National HIV Behavioral Surveillance (NHBS) data among PWID from 19 US metropolitan statistical areas (MSAs); we restricted the analytic sample to PWID self-reporting being HIV negative (N = 7477). Administrative data were analyzed to describe the 1. Sociodemographic Composition; 2. Economic disadvantage; 3. Healthcare Service/Law enforcement; and 4. HIV burden of the ZIP codes, counties, and MSAs where PWID lived. Multilevel models tested associations of place characteristics with HIV testing. Fifty-eight percent of PWID reported past-year testing. MSA-level per capita correctional expenditures were positively associated with recent HIV testing among black PWID, but not white PWID. Higher MSA-level household income and imbalanced sex ratios (more women than men) in the MSA were associated with higher odds of testing. HIV screening for PWID is suboptimal (58%) and needs improvement. Identifying place characteristics associated with testing among PWID can strengthen service allocation and interventions in areas of need to increase access to HIV testing.

Predictors of historical change in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993–2007

“…Previous research measured specialized resources useful for the community action being studied. Such actions have included SPP presence and HIV testing and treatment among PWID [4][5][6][7][38][39][40], as well as a broad range of programs such as providing condom distribution interventions or programs [20,21,36], or specialized programs for treatment of people who are mentally ill [40,41]. In the present study we found that, consistent with our hypotheses, having a larger community, public health, and social work workforce in MSAs predicted higher treatment coverage levels.…”

“…Despite this, however, relatively little is known about what determines their presence and reach. Much health policy discourse assumes that need for a program is associated with program presence or magnitudehowever our previous studies of the determinants of drug treatment coverage and syringe exchange presence have found that need is not a predictor of these programs for PWID [4][5][6][7]38]. The present study, similarly, has found that several key indicators of need were not related to 1993-2007 drug treatment coverage.…”

“…It has been used to identify a variety of place characteristics that are likely to affect the extent to which a community carries out and sustains an action. Rosser & Horvath for example, found that successful rural HIV prevention was less likely in states with more religious and Evangelical Protestant adherents and more successful in states with more "gay community" infrastructure [35]; and providing condom distribution interventions or programs [20,36], counseling and testing services [37,38], or specialized programs to reduce opiate misuse [3-7, 39, 40] or treatment for people who are mentally ill [41,42]. As previously conceived [3][4][5][6][7] this framework emphasizes five types of place characteristics as important to the distribution and implementation of institutionalized programs in cities or MSAs.…”

Racial/ethnic segregation and health disparities: Future directions and opportunities

“…Bellatorre et al () are among the first to empirically link segregation to allostatic load and Hao et al () extended segregation to cancer survivors' health‐related quality of life, though Massey () already proposed a theoretical connection between segregation and allostatic load. It should be noted that since 2017, several scholars have reported that segregation is related to the availability of health care resources (Caldwell et al, ), health behaviors (Tempalski et al, ; Thomas‐Hawkins et al, ), and neurological disorder (Pennap et al, ).…”

“…Four of the seven studies that explicitly measured white/Asians segregation found that Asians benefited from high segregation in terms of low risk of having a low birth weight baby and smoking during pregnancy (Walton, ; Yang et al, ), low odds of late‐stage breast cancer diagnosis (Mobley, Kuo, et al, ) and early‐stage breast cancer surgery (Ojinnaka et al, ), and low sodium‐potassium ratio (Yi et al, ). Thirteen studies did not find a significant relationship between racial/ethnic segregation and health disparities (Anderson & Fullerton, ; Biello, Niccolai, et al, ; Britton & Velez, ; Grigsby‐Toussaint et al, ; Haas, Earle, Orav, Brawarsky, Keohane, et al, ; Harvey et al, ; Kershaw et al, ; Kershaw & Albrecht, ; Kovalchik et al, ; Mendez et al, ; Piontak & Schulman, ; Plascak et al, ; Tempalski et al, ).…”