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Trepka MJ, Dawit R, Fernandez SB, Sheehan DM, Degarege A, PhD TL, Maddox LM, Spencer EC. Social disorganization and new HIV diagnoses, 2013-2017, Florida: Rural-urban differences. J Rural Health 2022; 38:960-969. [PMID: 34861068 PMCID: PMC9163207 DOI: 10.1111/jrh.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the role of neighborhood social disorganization factors on human immunodeficiency virus (HIV) diagnosis rates in urban and rural areas in Florida, we conducted an ecologic study of HIV diagnosis rates during 2013-2017 and social disorganization components, including concentrated disadvantage, ethnic heterogeneity, and residential instability. METHODS Indices of social disorganization components were obtained from principal component analyses of American Community Survey variables for 910 postal codes. Rural/urban classification was based on the United States Department of Agriculture Rural Urban Commuting Area codes. Using multivariable linear regression, the relationship between social disorganization indices and HIV diagnosis rates was assessed. FINDINGS The only social disorganization index that was significantly higher in rural than urban areas was concentrated disadvantage. In rural areas, the concentrated disadvantage index was significantly associated with HIV diagnosis rates (P = .007) when controlling for the other social disorganization factors but was no longer significant after additionally controlling for prevalence of people with an HIV diagnosis who were not virally suppressed. In urban areas, even after controlling for prevalence of people with HIV who were not virally suppressed, lower male-to-female population ratios and higher scores of residential instability, concentrated disadvantage, and LatinX/immigrant density indices were associated with higher HIV diagnosis rates (all P < .01). CONCLUSIONS In addition to improving community levels of viral suppression, the community contextual environment, including the rurality of the environment, needs to be considered in strategies to end the HIV epidemic in the United States.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th St, AHC 5, Miami, Florida, USA
| | - Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tan Li PhD
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Lorene M. Maddox
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
| | - Emma C. Spencer
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
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