The impact of regional socioeconomic deprivation on late HIV diagnoses: a cross-sectional study in Germany

Abstract

Background: Late HIV diagnoses are associated with significantly poorer health outcomes and facilitate onward transmission. The proportion of HIV infections diagnosed at advanced stages has remained continuously high in Germany. This study examined the effect of regional socioeconomic deprivation on late HIV presentation.Methods: We used data from the national statutory notification of newly diagnosed HIV cases collected between 2011 and 2018 with further information on the timing of diagnosis determined by the BED-Capture-ELISA test (BED-CEIA) and diagnosing physicians. Data on regional socioeconomic deprivation were derived from the German Index of Socioeconomic Deprivation (GISD). Outcome measures were a long-standing infection based on the BED-CEIA result or an infection at the stage of AIDS. The effect of socioeconomic deprivation on the timing of diagnosis was analysed using multivariable Poisson regression models with cluster-robust error variance.Results: Overall, 66.2% (n=6,185) of the patients were diagnosed with a long-standing infection and 13.1% (n=1,536) with AIDS. The proportion of late diagnoses was higher among persons with heterosexual contact compared to men who have sex with men (MSM) (76.5% long-standing and 16.4% AIDS vs. 62.4% long-standing and 11.9% AIDS). MSM living in highly deprived countryside regions were more likely to have a long-standing infection (aPR: 1.16, 95% CI 1.05-1.28) as well as AIDS (aPR: 1.41, 95% CI 1.08-1.85) at the time of diagnosis compared to MSM in less deprived countryside regions. No differences were observed among MSM from urban areas, and no differences overall among persons with heterosexual contact.Conclusions: An effect of socioeconomic deprivation on late HIV presentation was found only in MSM from countryside regions. We suggest that efforts in promoting HIV awareness and regular HIV testing are increased for heterosexual persons irrespective of socioeconomic background, and for MSM with a focus on persons living in deprived regions in the countryside.

Determinants of HIV late presentation among men who have sex with men in Portugal (2014–2019): who’s being left behind?

“…Another study in Germany included the German Index of Socioeconomic Deprivation of their residential area, based on the subdimensions of education, occupation, and income. The study concluded that only the MSM who live in the countryside versus urban areas were affected by socioeconomic deprivation, and there was no impact on MSM from towns or major cities (60). The association between higher income and LP can be explained by stigma surrounding HIV.…”