Neighborhood deprivation—i.e., low levels of education, employment, housing quality, and income—is negatively associated with HIV viral suppression in a given area, independent of that neighborhood’s racial/ethnic makeup, a single-center retrospective cohort study published in Clinical Infectious Diseases showed.
The results testify to the predominance of structural racism, rather than race per se, as a risk factor for lack of HIV viral suppression in the U.S., the study authors concluded.
The study included data on 947 PLWH attending the University of Nebraska clinic in Omaha, Nebraska, between 2012 and 2018. The city has a history of redlining and housing segregation, which helps to explain the race-independent disparities seen when applying per-neighborhood values from the Area Deprivation Index, which quantifies highly localized inequalities by assessing 17 different U.S. Census-derived measurements.
While various sociodemographic factors were considered, data did not allow for deep analyses by race, such as a distinction between African immigrants and U.S.-born African Americans. Reliance on ZIP codes to delineate neighborhoods also meant that unhoused people were excluded from the study. (Housing status has been previously associated with viral suppression rates.)
The study was conducted prior to COVID-19, but the respiratory virus also highlights the impact of structural determinants of health, a related commentary authored by Rupali K. Doshi, M.D., of George Washington University, and colleagues noted. They added that, beyond viral infections, neighborhood deprivation is also associated with the prevalence of non-infectious chronic diseases such as diabetes, as well as overall mortality and other health issues.
Healthcare providers need to be trained to identify system-level issues and should advocate for the elimination of such problems, in addition to examining how medical practice itself can perpetuate these inequities, Doshi et al urged.