The relationship between higher social trust and lower late HIV diagnosis and mortality differs by race/ethnicity: results from a state‐level analysis

Abstract

Introduction: Black men who have sex with men (MSM) continue to suffer a disproportionate burden of new HIV diagnoses and mortality. To better understand some of the reasons for these profound disparities, we examined whether the association between social trust and late HIV diagnosis and mortality differed by race/ethnicity, and investigated potential indirect effects of any observed differences.Methods: We performed generalized structural equation modelling to assess main and interaction associations between trust among one’s neighbours in 2009 (i.e. social trust) and race/ethnicity (Black, White, and Hispanic) predicting late HIV diagnosis (a CD4 count ≤200 cell/µL within three months of a new HIV diagnosis) rates and all-cause mortality rates of persons ever diagnosed late with HIV, across 47 American states for the years 2009–2013. We examined potential indirect effects of state-level HIV testing between social trust and late HIV diagnosis. Social trust data were from the Gallup Healthways Survey, HIV data from the Centers for Disease Control and Prevention, and HIV testing from the Behavioral Risk Factor Surveillance System. Covariates included state-level structural, healthcare, and socio-demographic factors including income inequality, healthcare access, and population density. We stratified analysis by transmission group (male-to-male, heterosexual, and injection drug use (IDU)).Results: States with higher levels of social trust had lower late HIV diagnosis rates: Adjusted Rate Ratio [aRR] were consistent across risk groups (0.57; 95%CI 0.53–0.62, male-to-male), (aRR 0.58; 95%CI 0.54–0.62, heterosexual) and (aRR 0.64; 95%CI 0.60–0.69, IDU). Those associations differed by race/ethnicity (all p < 0.001). The associations were most protective for Blacks followed by Hispanics, and least protective for Whites. HIV testing mediated between 18 and 32% of the association between social trust and late HIV diagnosis across transmission group but for Blacks relative to Whites only. Social trust was associated with lower all-cause mortality rates and that association varied by race/ethnicity within the male-to-male and IDU transmission groups only.Conclusions: Social trust may promote timely HIV testing, which can facilitate earlier HIV diagnosis, thus it can be a useful determinant to monitor the relationship with HIV care continuum outcomes especially for racial/ethnic minority groups disproportionately infected by HIV.

Social capital and HIV/AIDS in the United States: Knowledge, gaps, and future directions

“…One of the 13 studies was a qualitative analysis ( Cene et al, 2011 ) and the remaining 12 were quantitative. Five employed ecological designs at various geographic units such as states, ZIP codes, and Census tracts ( Holtgrave and Crosby, 2003 , Ransome et al, 2016a , Ransome et al, 2016c , Ransome et al, 2016b , Ransome et al, 2017 , Ransome et al, 2017a ). Three studies were of the entire contiguous US ( Holtgrave and Crosby, 2003 , Grosso, 2010 , Ransome et al, 2017a ), three were based on samples from the Northeast region ( Ransome et al, 2016 , Ransome et al, 2016b , Ransome et al, 2017 ), two from the Southern region ( Cene et al, 2011 , Phillips, 2011 ), two from the Midwest and West ( Webel et al, 2013 , Webel et al, 2016 ), and two included samples from populations dispersed across selected states within the US (e.g., Texas, California, Massachusetts) ( Nokes et al, 2012 , Webel et al, 2012 ).…”

“…Only two studies examined the relation between social capital and a prevention measure, which was HIV testing ( Grosso, 2010 , Cene et al, 2011 ). Seven studies examined the relationship between social capital and HIV or AIDS diagnosis prevalence ( Holtgrave and Crosby, 2003 , Cene et al, 2011 , Webel et al, 2012 , Ransome et al, 2016a , Ransome et al, 2016c , Ransome et al, 2016b , Ransome et al, 2017a , Ransome et al, 2017b ). Two studies examined the association with linkage to HIV care ( Ransome et al, 2016b , Ransome et al, 2017b ), and two studies with engagement and retention in HIV care ( Webel et al, 2013 , Ransome et al, 2016b ).…”

“…Five studies examined social capital in relation to some aspect of antiretroviral therapy (ART), mostly with a focus on adherence ( Phillips, 2011 , Nokes et al, 2012 , Webel et al, 2012 , Phillips et al, 2013 , Webel et al, 2016 ). One study assessed the association with viral suppression ( Webel et al, 2012 ), and one study examined the association with mortality among persons living with HIV ( Ransome et al, 2017a ).

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“…Social capital is hypothesized to have a protective relationship with health. Seven of the twelve quantitative studies (58%) documented a protective association between at least one social capital measure and an HIV/AIDS outcome, using methods that included correlation and regression analysis ( Holtgrave and Crosby, 2003 , Grosso, 2010 , Nokes et al, 2012 , Phillips et al, 2013 , Webel et al, 2013 , Webel et al, 2016 , Ransome et al, 2017a ). However, while a protective association was observed among those seven studies, the association remained significant after adjustment for covariates in all but one study, which did not report the final coefficient to determine whether the direct effect was meaningful ( Nokes et al, 2012 ).…”

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

“…Lastly, the association between social capital and health outcomes such as HIV diagnosis is context dependent [87] . However, given recent studies documenting an association with HIV care continuum outcomes net other traditional contextual factors such as income inequality [32, 88] ; we recommend that social capital questions be included and routinely collected in both national and local health or other demographic surveys when possible.…”