Social Capital is Associated With Late HIV Diagnosis: An Ecological Analysis

Abstract

Background Late HIV diagnosis is associated with higher medical costs, early mortality among individuals, and HIV transmission in the population. Even under optimal configurations of stable or declining HIV incidence and increase in HIV case findings, no change in proportion of late HIV diagnosis is projected after year 2019. We investigated the association among social capital, gender, and late HIV diagnosis. Methods We conduct ecological analyses (ZIP code, N=166) using negative binomial regression of gender-specific rates of late HIV diagnoses (an AIDS defining illness or a CD4 count ≤200 cell/µL within 12 months of a new HIV diagnosis) in 2005 and 2006 obtained from the New York City HIV Surveillance Registry, and social capital indicators (civic engagement, political participation, social cohesion, and informal social control) from the New York Social Indicators Survey, 2004. Results Overall, low to high political participation and social cohesion corresponded with significant (p<.0001) decreasing trends in late HIV diagnosis rates. Among men (RR=0.66, 95% CI [0.47—0.98]) and women (RR=0.43, 95% CI [0.28—0.67]), highest political participation was associated with lower relative odds of late HIV diagnosis, independent of income inequality. Highest informal social control (RR=0.67, 95% CI [0.48—0.93]) among men only, and moderate social cohesion (RR=0.71, 95% CI [0.55—0.92]) among women only, were associated with the outcome adjusting for social fragmentation, income inequality, and racial composition. Discussion The magnitude of association between social capital and late HIV diagnosis varies by gender and by social capital indicator.

Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement

“…The direction found in this study is similar to the direction found by Ransome, Galea and Pabayo et al among men [85], measured by a civic engagement indicator that includes a component of participating in local organizations, just as in this study. While in general, social capital would be expected to be associated with lower late HIV diagnosis, the directions found in these two studies may indicate a complex pattern more detailed data are required to answer.…”

Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing

“…We observed in our study that income inequality and socioeconomic deprivation was associated with higher rates of late HIV diagnosis but only in crude models, not adjusted for covariates. The direction of association was consistent with crude results from one study that examined HIV incidence (Buot et al, 2014), one study that examined AIDS mortality rates among injection drug users (Friedman et al, 2013), and multivariable results from one study that examined late HIV diagnosis based on 2005–6 HIV data (Ransome et al, 2016). …”

“…In contrast, in multivariable models; for women compared to men, black racial concentration appeared to have a larger magnitude of association on late HIV diagnosis. One ecological study in NYC based on late HIV diagnosis data from 2005 to 2006 also found the same pattern of association between black racial concentration and late HIV diagnosis for women compared to men (Ransome et al, 2016). …”

How Do Social Capital and HIV/AIDS Outcomes Geographically Cluster and Which Sociocontextual Mechanisms Predict Differences Across Clusters?

“…Thus, we cannot generalize the findings to other indicators such as social cohesion or collective efficacy. However, in previous HIV and social capital research, social/civic/political participation was highly positively correlated with other social capital indicators such as collective efficacy, social cohesion, and informal social control [32] . We also could not analyze participation by the type of organizations (e.g.…”

“…The preponderance of evidence documenting a protective association between social capital and HIV risks and HIV care continuum outcomes has been among international populations [25, 27–31] and there are only a handful of ecological studies on the topic in the US [32–35] . One state-level ecological study using data from year 1999 showed that higher social capital was associated with lower AIDS case rates [34] .…”