HIV Diagnoses and Social Disorganization: Rural-Urban Differences in Florida

There are over 1 million people living with HIV in the US, but certain areas are more affected than others.

The South has the highest rates of HIV incidence, and these are the greatest in rural areas. In 2018, HIV diagnosis rates in the rural South were 3.8-fold higher than in the metropolitan Northeast.

Investigators from Florida International University’s’ Robert Stempel College of Public Health and Social Work

The study, published in The Journal of Rural Health, compared neighborhood social disorganization factors on HIV incidence rates between urban and rural Florida.

The ecological study examined HIV infection rates alongside social disorganization components like ethnic heterogeneity, concentrated disadvantage, and residential instability.

The investigators obtained the number of people living with HIV (PWH) from 2013-2017 via ZIP code from the Florida Enhanced HIV/Acquired Immunodeficiency Syndrome (AIDS) Reporting System. Additionally, they collected the number not virally suppressed PWH (nvsPWH). HIV viral load suppression was defined by having fewer than 200 copies per mL of blood.

Based on previous findings that HIV and AIDS diagnoses and socioeconomic status differed between rural and urban settings, all analyses were stratified by rural or urban classification.

The investigators used multivariable linear regression to test the relationship between HIV diagnosis rates and social disorganization factors, controlling for gender and nvsPWH prevalence.

The final analysis included 65 rural areas and 845 urban areas in Florida. The male-to-female ratio was higher in urban areas, and the residential instability and Latinx/immigrant densities were lower in rural areas. The concentrated disadvantage index indicated that urban areas were generally wealthier than rural areas.

From 2013-2017, there were 22479 HIV diagnoses among people 15 and older. Diagnosis rates were significantly higher in urban areas than rural areas, but the nvsPWH prevalence was not significantly different.

In urban areas, LatinX/immigrant density index was most correlated with HIV diagnosis rate, followed by the residential instability index and concentrated disadvantage index, all of which were significant. In rural areas, concentrated disadvantage index and residential instability correlations with HIV prevalence were significant.

In urban Florida, higher residential instability, concentrated disadvantage, Latinx/immigrant density index, and lower male-to-female sex ratio were associated with higher HIV diagnosis rates. In rural Florida, poverty was associated with higher HIV diagnosis rates.

The investigators concluded that promoting viral suppression among people living with HIV is crucial to preventing future infections. Even after adjusting the results, they found that neighborhood contextual factors were correlated with HIV incidence, especially in urban areas.

In urban areas, HIV diagnosis rates were associated with social disorganization factors. The lack of statistical significance of neighborhood contextual factors driving HIV infections in rural areas may require a different method of assessment or a larger study