Impact of Neighborhood-Level Socioeconomic Status on HIV Disease Progression in a Universal Health Care Setting

Abstract

In a setting where treatment for HIV is free of charge, a significant number of HIV-positive persons did not access HAART. Low socioeconomic status was associated with this delay and with increased mortality among persons receiving HAART. Social and health policy initiatives, beyond free and universal health care, are required to optimize access to HAART.

Socioeconomic Status and Survival of People with Human Immunodeficiency Virus Infection before and after the Introduction of Highly Active Antiretroviral Therapy: A Systematic Literature Review

“…Seven reports provided data on survival of persons with AIDS (PWAs) only [34,71,72,79,80,85,88], one examined survival of HIV-infected parents of adolescents [73], one looked at survival in HIV-infected children [78], and the remaining studies assessed HIV-infected patients of both genders and various age groups (Table 1). While the majority of retrieved publications looked at all-cause mortality in individuals diagnosed with HIV/AIDS, two Canadian reports [75,83] and one US study [80] covering the post-HAART period described HIV/ AIDS-related mortality. Crude HR or RR of death was reported in eight studies and adjusted measures of association were found in the remaining (Table1).…”

“…Four studies examined effects of SES on mortality with HIV/AIDS in the years of pre-HAART period [70][71][72][73]. Fifteen studies provided an assessment of SES in relation to survival in HIV-infected patients during the years of commercial availability of HAART [74][75][76][77][78][79][80][81][82][83][84][85][86][87][88]. Two studies [34,35] evaluated the impact of SES on survival with HIV/AIDS in both periods.…”

Neighborhood-level Determinants of Delayed HIV Diagnosis and Survival among HIV-positive Latinos, Florida 2000-2011

“…Neighborhood poverty was not consistently associated with mortality for Latinos with history of IDU, and appeared to be protective, but was a risk factor for mortality for universal health care setting that found no disparity in mortality risk between injection drug users and non-injection drug users (Joy et al, 2008). However, our study differs in that our sample included only Latinos, and included individuals with and without access to care.…”

“…Contributing to the association between neighborhood disadvantage and drug use behaviors are increased psychological stress, decreased positive social networks, and fewer health and social support services (Boardman et al, 2001, Galea et al, 2003, Kirby and Toshiko, 2005. Neighborhood disadvantage also is associated with increased mortality risk among the general HIV-positive population , Joy et al, 2008, McFarland et al, 2003. However, no studies to date have examined the association between neighborhood socioeconomic status (SES) and mortality among HIV-positive injection drug users.…”

“…Additionally, neighborhood-level educational attainment has been associated with late HIV diagnosis in urban areas (Trepka et al, 2014). Areas with low SES have also been associated with low HIV and AIDS survival , Joy et al, 2008, McFarland et al, 2003.…”