Racial and sex disparities in HIV screening outcomes within emergency departments of Harris County, Texas

Abstract

Objectives The emergency department provides opportunities for identifying undiagnosed HIV cases. We sought to describe the racial and sex epidemiology of HIV through ED screening in Harris County, Texas, one of the most diverse and populous metropolitan cities in the Southern United States. Methods We used a descriptive secondary analysis of a universal HIV screening program (2010–2017) to quantify demographic differences in HIV incidence. We applied a validated codebook to a dataset by the local health department containing 894,387 records of ED visits with 62 variables to assess race/ethnicity and sex differences. Results Of 885,199 (98.9%) patients screened for HIV during an ED visit, 1795 tested positive (incidence rate = 0.2%). Of those tested for HIV, most were White (66.3%), followed by racial minorities (African Americans (29.9%), Asians (3.6%), and American Indian, Alaska Native, Native Hawaiian or Pacific Islanders (natives) (0.1%). Half of those tested were Hispanic. Conversely, of patients testing positive (n = 1782, 99.3% of positive cases), most were African American (52.6%) followed by Whites (46.6%), Asians (0.7%), and natives (0.1%). Less than half (35.5%) of positives were Hispanic. A racial disparity in HIV incidence was discovered among African American females. This group represented 16.8% of the tested population; yet accounted for 65.8% of females who tested positive for HIV and 20.3% of all HIV‐positive test results. Conclusion Descriptive findings of the racial and sex epidemiology of HIV revealed that African American females had the largest disparity between the population tested and those who tested positive for HIV.

High Rate of HIV Among Trauma Patients Participating in Routine Emergency Department Screening

“…While the association between trauma and likelihood of HIV infection loses statistical significance when adjusted for demographic factors such as age, race and gender, this can largely be attributed to the fact that the trauma population is predominantly comprised of young, Black males, and these demographic characteristics are known to be strong independent predictors of HIV infection, [ 25 ] an association that was supported by the data in this study. Even if demographics are driving the higher prevalence of HIV in the trauma population, this demographic overlap suggests that the ED encounter for a traumatic event represents a critical opportunity to provide screening, and potentially even HIV prevention interventions, to a priority group that may otherwise have little contact with the healthcare system.…”

Projected Life Expectancy Gains From Improvements in HIV Care in Black and White Men Who Have Sex With Men

“…To achieve an equitable care continuum, there is a need for investment in and prioritization of evidence-based, multilevel interventions developed to meet the needs of Black MSM in different community contexts and that consider local HIV epidemic dynamics. 33 , 34 , 35 , 36 For example, it is essential to address structural issues due to health care infrastructure (eg, dearth of HIV practitioners, lack of Medicaid expansion, and medical mistrust) that are associated with a higher burden of HIV in the US South and to develop tailored interventions focused on the community and cultural context for Black MSM residing in the US South. Such interventions are also likely to provide benefits to the community at large by reducing forward transmission of HIV (eg, treatment as prevention) among other benefits.…”

Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities—HPTN 073

“…Thus, SDT provides a theoretical framework that clinicians and counselors can use to inform their MI techniques and practices [60]. SDT can also be applied to novel structural approaches to HIV prevention such as HIV testing in emergency departments [61,62] and HIV self-testing [63][64][65][66][67][68] combined with community-based initiation of PrEP or HIV treatment. SDT has a long history of application in health domains and its utility for HIV/STI prevention can spur new intervention approaches to help accelerate progress towards ending the HIV epidemic in the US.…”