The impact of regional socioeconomic deprivation on the timing of HIV diagnosis: a cross-sectional study in Germany

Abstract

Background HIV infections which are diagnosed at advanced stages are associated with significantly poorer health outcomes. In Germany, the proportion of persons living with HIV who are diagnosed at later stages has remained continuously high. This study examined the impact of regional socioeconomic deprivation on the timing of HIV diagnosis. Methods We used data from the national statutory notification of newly diagnosed HIV infections 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 non-recent 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, 67.5% (n = 10,810) of the persons were diagnosed with a non-recent infection and 15.2% (n = 2746) with AIDS. The proportions were higher among persons with heterosexual contact compared to men who have sex with men (MSM) (76.8% non-recent and 14.9% AIDS vs. 61.7% non-recent and 11.4% AIDS). MSM living in highly deprived regions in the countryside (< 100 k residents) were more likely to have a non-recent 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 regions in the countryside. No differences were observed among MSM from towns (100 k ≤ 1 million residents) or major cities (≥ 1 million residents), and no differences overall in the heterosexual transmission group. Conclusions An effect of socioeconomic deprivation on the timing of HIV diagnosis 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 those 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.…”

Prevalence, characteristics and challenges of late HIV diagnosis in Germany: an expert narrative review

“…Data from HIV-Regional (2014), covering 31 HIV-focused centers (15 hospital outpatient clinics and 16 medical practices) reported late HIV diagnosis in 55.6% of 971 patients, with 33.5% having advanced HIV disease [ 3 , 14 ]. Data from the national statutory notification of newly diagnosed HIV infections (2011–2018) reported diagnosis with a non-recent HIV infection (defined as an infection diagnosed after a mean duration of more than five months since it was acquired [as determined by the BED-Capture-ELISA]) in 67.5% of 16,010 patients, with 15.2% (2746/18,092) diagnosed with AIDS [ 15 ]. These findings are consistent with the most recent national surveillance report showing that 33.0% of new diagnoses in 2021 were for advanced HIV disease (Fig.…”

“…Regional socioeconomic status also affects the likelihood of late diagnosis, but only for certain population groups. Data from the national statutory notification of newly diagnosed HIV infections (2011–2018) showed that MSM living in highly deprived regions in the countryside were more likely to be diagnosed late than those living in less-deprived areas [ 15 ]. However, this difference was not observed in MSM from towns or major cities.…”

“…However, this difference was not observed in MSM from towns or major cities. Although individuals with heterosexual contact were generally at a higher risk of being diagnosed late with HIV compared with MSM, for heterosexuals, this risk was unrelated to their socioeconomic status [ 15 ]. A retrospective study of people with HIV in Dresden, Germany (1986–2010), identified a positive syphilis screening test in MSM as a significant determinant for lower risks of late diagnosis, suggesting that HIV prevention strategies may benefit from a focus on the diagnosis of other (often co-occurring) sexually transmitted infections [ 17 ].…”

AIDS in the era of antiretroviral therapy: Changes in incidence rates and predictors of AIDS among people living with HIV under clinical care in Germany, a cohort study 1999–2018

“…As the ART Cohort Collaboration model was developed more than a decade ago, we aimed to examine the predictive accuracy of these established contributors with current data. Moreover, we were interested in further analysing the predictive utility of transmission mode because it is a complex variable comprising a wide range of factors and findings about its role regarding HIV progression have repeatedly been conflicting [18,19].…”