BACKGROUND:Anal cancer screening is recommended for people with HIV in the United States (US). Because HIV prevalence varies geographically, the distribution of anal cancer diagnoses occurring among people with HIV may also differ by geography. Characterizing geographic variation can help identify areas needing enhanced screening infrastructure and outreach. METHODS:Using data from the HIV/AIDS Cancer Match Study, US cancer registries, and CDC's National HIV Surveillance System, we estimated the proportion of incident anal squamous cell carcinomas (SCC) among people with HIV across the 50 states, the District of Columbia (DC), and major metropolitan statistical areas (MSAs). RESULTS:During 2010-2019, an average of 2,160 anal SCC diagnoses occurred annually among males, 414 (20.1%; Uncertainty Interval [UI]=19.4%-20.6%) among males with HIV. Among females, 58 of an average 4,099 annual anal SCC diagnoses (1.4%; UI = 1.3%-1.5%) occurred among females with HIV. Geographic variation among males was substantial. California had the highest annual number of anal SCC diagnoses among males with HIV (70/239; 29.2% [UI = 26.7%-31.8%]), followed by New York (48/161; 29.8% [UI = 26.3%-33.4%]), Florida (42/182; 23.1% [UI = 20.3%-26.1%]), Texas (36/132; 27.0% [UI = 23.7%-30.4%]), and Georgia (20/80; 25.2% [UI = 20.9%-29.8%]). New York had the highest annual number of diagnoses among females with HIV (10/263; 3.7% [UI = 3.0%-4.5%]). Across MSAs, the highest burden was in New York-Jersey City-White Plains (57 diagnoses [UI = 43-73]), with several MSAs in California, Texas, and Florida also showing a high burden. DISCUSSION:Geographic differences underscore the need for targeted anal cancer screening outreach and implementation.

BACKGROUND:In 2019, there were an estimated 1.2 million persons with HIV (PWH) and 35,100 new infections in the United States. The HIV care continuum has a large influence on transmission dynamics. METHODS:We updated Progression and Transmission of HIV 3.0, an agent-based simulation model, to estimate 2019 HIV transmission rates and distribution of transmissions by the HIV care continuum, race/ethnicity, transmission group, and age group. RESULTS:In 2019, the estimated transmission rate in the United States was 2.94 new infections per 100 person-years ( inf/100p-y) . Transmission rates decreased along the HIV care continuum; the highest transmission rate was associated with persons with acute HIV infection and unaware of their HIV status at 16.35 inf/100p-y , followed by PWH (nonacute) and unaware of their HIV status (9.52), persons aware of their HIV status and not in care (5.96), persons receiving HIV care (on antiretroviral therapy) but not virally suppressed (4.53), and persons virally suppressed (0). The highest transmission rate by transmission group was among men who have sex with men at 3.68 inf/100p-y . Transmission rates decreased as age increased and are similar by race/ethnicity, after accounting for the HIV care continuum. CONCLUSIONS:Our results support a continued emphasis on helping PWH move along the care continuum through early diagnosis, linkage to care, and adherence to ART, resulting in viral suppression to reduce HIV transmissions. Furthermore, efforts should focus on reducing disparities in the provision of HIV prevention and care services, particularly for populations disproportionally affected by HIV.

BACKGROUND:The HIV Prevention Trials Network (HPTN) 096 study was designed to address the markedly higher rates of HIV incidence among Black men who have sex with men (MSM) in the Southern United States (US). A cross-sectional assessment was conducted during the pilot phase of the study to determine its feasibility and collect key HIV-related metrics for the study population. METHODS AND FINDINGS:Four hundred and twenty-two Black MSM, ≥ 15 years old and living in the four pilot communities (Dallas, TX; Houston, TX; Montgomery, AL; Greenville, SC), were enrolled via starfish sampling into the cross-sectional assessment. Each participant completed two questionnaires and had blood samples collected at a single study visit. Laboratory testing was performed to determine HIV status and use of oral pre-exposure prophylaxis (PrEP). HIV drug resistance and viral suppression were also assessed for two of the four pilot communities (Dallas and Houston). Categorical variables were summarized using frequency and percentage. Continuous variables were summarized using mean, standard deviation, median and interquartile range. Univariable and multivariable logistic regression models were used to assess various associations. HIV status was determined for 403 of the 422 participants (95.5%); 212 (52.6%) men were living with HIV, including one with acute HIV. For these participants, 163 (76.9%) reported that they were in HIV care. In Dallas and Houston, 71 of the 101 living with HIV (70.3%) were virally suppressed. Of the 191 not living with HIV, 57 (29.8%) reported ever taking PrEP, 41 (21.5%) reported being currently on PrEP, and eight (4.2%) reported never having heard of PrEP. PrEP use was documented through laboratory testing in 36 (19.1%) of 188 participants tested; of the 41 participants reporting current PrEP use, five did not have laboratory evidence of PrEP use. CONCLUSION:During the pilot, we successfully recruited Black MSM using starfish sampling and demonstrated the feasibility of collecting primary study outcomes using a cross-sectional assessment. We found a high burden of HIV and those living with HIV had only a moderate rate of viral suppression. In addition, PrEP use was uncommon among the men living without HIV. Reducing HIV incidence in Black MSM remains a key element to addressing the HIV epidemic in the US.

Objective COVID-19 and related disruptions led to a significant drop in HIV diagnoses in the US in 2020. Recent analyses found 18% fewer diagnoses than expected among persons with HIV (PWH) acquiring infection in 2019 or earlier, suggesting that the drop in diagnoses cannot be attributed solely to decreased transmission. This analysis evaluates the progress made towards closing the 2020 diagnosis deficit in 2021. Methods We apply modified versions of previously developed methods analyzing 2021 diagnosis data from the National HIV Surveillance System to determine whether the 2021 diagnosis levels of PWH infected pre-2020 are above or below the projected pre-COVID trends. We apply these analyses on stratifications based on assigned sex at birth, transmission group, geographic region, and race/ethnicity. Results In 2021, HIV diagnoses returned to pre-COVID levels among all PWH acquiring infection 2011-19. Among Hispanic/Latino PWH and males, diagnoses returned to pre-COVID levels. White PWH, men who have sex with men, and PWH living in the south and northeast showed higher-than-expected levels of diagnosis in 2021. For the remaining populations, there were fewer HIV diagnoses in 2021 than expected. Conclusions While overall diagnoses returned to pre-COVID levels, the large diagnosis gap observed in 2020 remained unclosed at the end of 2021. Lower than expected diagnosis levels among certain populations indicates that COVID-19 related disruptions to HIV diagnosis trends were present in 2021. Although some groups showed higher-than-projected levels of diagnoses, such increases were smaller than the corresponding 2020 decreases. Expanded testing programs designed to close these gaps are essential.

HIV infection is monitored through the National HIV Surveillance System (NHSS) to help improve the health of people with HIV and reduce transmission. NHSS data are routinely used at federal, state, and local levels to monitor the distribution and transmission of HIV, plan and evaluate prevention and care programs, allocate resources, inform policy development, and identify and respond to rapid transmission in the United States. We describe the expanded use of HIV surveillance data since the 2013 NHSS status update, during which time the Centers for Disease Control and Prevention (CDC) coordinated to revise the HIV surveillance case definition to support the detection of early infection and reporting of laboratory data, expanded data collection to include information on sexual orientation and gender identity, enhanced data deduplication processes to improve quality, and expanded reporting to include social determinants of health and health equity measures. CDC maximized the effects of federal funding by integrating funding for HIV prevention and surveillance into a single program; the integration of program funding has expanded the use of HIV surveillance data and strengthened surveillance, resulting in enhanced cluster response capacity and intensified data-to-care activities to ensure sustained viral suppression. NHSS data serve as the primary source for monitoring HIV trends and progress toward achieving national initiatives, including the US Department of Health and Human Services’ Ending the HIV Epidemic in the United States initiative, the White House’s National HIV/AIDS Strategy (2022-2025), and Healthy People 2030. The NHSS will continue to modernize, adapt, and broaden its scope as the need for high-quality HIV surveillance data remains.

Objective:Coronavirus disease 2019 (COVID-19) and related disruptions led to a significant decline in HIV diagnoses in the United States in 2020. A previous analysis estimated 18% fewer diagnoses than expected among persons with HIV (PWH) acquiring infection in 2019 or earlier, suggesting that the decline in overall diagnoses cannot be attributed solely to decreased transmission. This analysis evaluates the progress made towards closing the 2020 diagnosis deficit in 2021.Methods:We apply previously developed methods analyzing 2021 diagnosis data from the National HIV Surveillance System to determine whether 2021 diagnosis levels of PWH infected pre-2020 are above or below the expected pre-COVID trends. Results are stratified by assigned sex at birth, transmission group, geographic region, and race/ethnicity.Results:In 2021, HIV diagnoses returned to pre-COVID levels among all PWH acquiring infection 2011-2019. Among Hispanic/Latino PWH and male individuals, diagnoses returned to pre-COVID levels. White PWH, MSM, and PWH living in the south and northeast showed higher-than-expected levels of diagnosis in 2021. For the remaining populations, there were fewer HIV diagnoses in 2021 than expected.Conclusion:Although overall diagnoses among persons acquiring HIV pre-2020 returned to pre-COVID levels, the diagnosis gap observed in 2020 remained unclosed at the end of 2021. Fewer than expected diagnoses among certain populations indicate that COVID-19-related disruptions to HIV diagnosis trends remained in 2021. Although some groups showed higher-than-expected levels of diagnoses, such increases were smaller than corresponding 2020 decreases. Expanded testing programs designed to close these gaps are essential.

To examine associations between Index of Concentration at the Extremes (ICE) measures (proxy for structural racism) for economic and Hispanic/Latino-White racial segregation and HIV outcomes among adults in the U.S. Census tract-level HIV diagnoses, linkage to HIV medical care within 1 month of diagnosis (linkage), and viral suppression within 6 months of diagnosis (viral suppression) data for 2021 from the National HIV Surveillance System were used. Three ICE measures were obtained from the American Community Survey: ICEincome (income segregation), ICErace (Hispanic/Latino-White racial segregation), and ICEincome + race (Hispanic/Latino-White racialized economic segregation). Rate ratios (RRs) for HIV diagnosis and prevalence ratios (PRs) for linkage and viral suppression were used to examine differences in HIV outcomes across ICE quintiles with Quintile5 (Q5: most privileged) as reference group and adjusted by selected characteristics. Among the 32,529 adults, diagnosis rates were highest in Quintile1 (Q1: most deprived) for ICEincome (28.7) and ICEincome + race (28.4) and Q2 for ICErace (27.0). We also observed higher RRs in HIV diagnosis and lower PRs in linkage and viral suppression (except for ICErace for linkage) in Q1 compared to Q5. Higher RRs and lower PRs in ICE measures were observed among males (diagnosis), adults aged 18‒34 (diagnosis and linkage) and aged ≥ 45 (viral suppression), and among adults in the South (all 3 HIV outcomes). Barriers in access to care/treatment in more Hispanic/Latino-White racialized economic segregated communities perpetuate the disproportionate impact of HIV on the population. Removing barriers to HIV care/treatment created by systemic racism/segregation may improve HIV outcomes and reduce disparities.

Assessing individual- and community-level factors may help to explain differences among Hispanic/Latino adults with diagnosed HIV not linked to care and without viral suppression in the United States. We analyzed CDC’s National HIV Surveillance System data among Hispanic/Latino persons aged ≥ 18 years with HIV diagnosed during 2021 in 47 states and the District of Columbia and linked cases via census tracts to the CDC/ATSDR’s Social Vulnerability Index (SVI). Adjusted prevalence ratios and 95

OBJECTIVE:Assessing mobility among people with HIV is an important consideration when measuring HIV incidence, prevalence, and the care continuum in the United States. Our aims were to measure mobility among people with HIV compared with the general population and to examine factors associated with migration among people with HIV. METHODS:We calculated state-to-state move-in and move-out migration rates for 2011 through 2019 using National HIV Surveillance System data for people with HIV and using US Census data for the general population. For people with HIV, we also assessed the association between migration and HIV care outcomes. RESULTS:From 2011 through 2019, the US general population had stable migration, whereas migration rates among people with HIV fluctuated and were higher than among the general population. Among people with HIV, migration rates in 2019 were higher among people assigned male sex at birth versus female sex at birth, among people aged ≤24 years versus ≥25 years, among people with HIV infection attributed to male-to-male sexual contact versus other transmission categories, and among non-Hispanic Other people (ie, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, or multiple races) versus Hispanic, non-Hispanic Black, and non-Hispanic White people. Receipt of HIV medical care (90.3% vs 75.5%) and achieving viral suppression (72.1% vs 65.3%) were higher among people with HIV who migrated versus those who did not. CONCLUSIONS:People with HIV in the United States are more mobile than the general population. Determining the mobility of people with HIV can help with strategic allocation of HIV prevention and care resources.

To identify trends in HIV diagnosis disparities among subpopulations of Black/African American and White persons by selected characteristics (i.e., sex assigned at birth, age group, and region of residence) in the United States during 2017‒2021. Four-year estimated annual percent change (EAPC) during 2017‒2021, 2020 was excluded due to the impact of COVID-19 on HIV diagnoses, was used to assess temporal trends in diagnosis rates and disparities by selected characteristics for Black and White persons aged ≥ 13 years with a diagnosis of HIV infection. Data reported through December 2022 to the National HIV Surveillance System (NHSS) were used. Among 74,161 Black persons and 44,641 White persons with HIV diagnosed during 2017–2021, there was an overall increase in HIV diagnosis rates among White females (EAPC = 2.0; CI = 0.3, 3.8), White males aged 35‒44 years (EAPC = 1.8; CI = 0.2, 3.5) and whose infection was attributed to injection drug use (EAPC = 7.5; CI = 4.6, 10.4), White females aged 35‒44 years (EAPC = 5.3; CI = 1.9, 8.9) and residing in the Midwest (EAPC = 5.5; CI = 1.4, 9.7). Among both Black and White males, we observed increases in relative disparities in HIV diagnosis for males aged 13‒24 years (EAPC = 7.4; CI = 7.0, 7.7) and residing in the West (EAPC = 2.0; CI = 1.1, 2.9). Efforts should prioritize eliminating disparities in treatment and prevention services by taking a comprehensive approach and actively mitigating the social determinants contributing to HIV disparities.

Black men who have sex with men (MSM) have been consistently reported to have the highest estimated HIV incidence and prevalence among MSM. Despite broad theoretical understanding that discrimination is a major social and structural determinant that contributes to disparate HIV outcomes among Black MSM, relatively little extant research has empirically examined structural discrimination against sexual minorities as a predictor of HIV outcomes among this population. The present study therefore examines whether variation in policies that explicitly discriminate against lesbian, gay, and bisexual (LGB) people and variation in policies that explicitly protect LGB people differentially predict metropolitan statistical-area-level variation in late HIV diagnoses among Black MSM over time, from 2008 to 2014. HIV surveillance data on late HIV diagnoses among Black MSM in each of the 95 largest metropolitan statistical areas in the United States, from 2008 to 2014, were used along with data on time-varying state-level policies pertaining to the rights of LGB people. Results from multilevel models found a negative relationship between protective/supportive laws and late HIV diagnoses among Black MSM, and a positive relationship between discriminative laws and late HIV diagnoses among Black MSM. These findings illuminate the potential epidemiological importance of policies pertaining to LGB populations as structural determinants of HIV outcomes among Black MSM. They suggest a need for scrutiny and elimination of discriminatory policies, where such policies are currently in place, and for advocacy for policies that explicitly protect the rights of LGB people where they do not currently exist.

BACKGROUND:To reduce health disparities and improve the health of Americans overall, addressing community-level social and structural factors, such as social vulnerability, may help explain the higher rates of HIV diagnoses among and between race/ethnicity groups. METHODS:Data were obtained from CDC's National HIV Surveillance System (NHSS) and the CDC/ATSDR social vulnerability index (SVI). NHSS data for Black, Hispanic/Latino, and White adults with HIV diagnosed in 2018 were linked to SVI data. To measure the relative disparity, rate ratios (RRs) with 95% CIs were calculated to examine the relative difference comparing census tracts with the lowest SVI scores (quartile 1, Q1) to those with the highest SVI scores (quartile 4, Q4) by sex assigned at birth for age group and region of residence. Differences in the numbers of diagnoses across the quartiles were analyzed by sex assigned at birth and transmission category. RESULTS:There were 13,807 Black, 8747 Hispanic/Latino, and 8325 White adults who received a diagnosis of HIV infection in the United States in 2018-with the highest HIV diagnosis rates among adults who lived in census tracts with the highest vulnerability (Q4). For each race/ethnicity and both sexes, the rate of HIV diagnoses increased as social vulnerability increased. The highest disparities in HIV diagnosis rates by SVI were among persons who inject drugs, and the highest within-group RRs were typically observed among older persons and persons residing in the Northeast. CONCLUSION:To reach the goals of several national HIV initiatives, efforts are needed to address the social vulnerability factors that contribute to racial and ethnic disparities in acquiring HIV and receiving care and treatment.

Objective(s) To examine associations between Index of Concentration at the Extremes (ICE) measures for economic and racial segregation and HIV outcomes in the United States (U.S.) and Puerto Rico. Methods County-level HIV testing data from CDC’s National HIV Prevention Program Monitoring and Evaluation and census tract-level HIV diagnoses, linkage to HIV medical care, and viral suppression data from the National HIV Surveillance System were used. Three ICE measures of spatial polarization were obtained from the U.S. Census Bureau’s American Community Survey: ICEincome (income segregation), ICErace (Black-White racial segregation), and ICEincome+race (Black-White racialized economic segregation). Rate ratios (RRs) for HIV diagnoses and prevalence ratios (PRs) for HIV testing, linkage to care within 1 month of diagnosis, and viral suppression within 6 months of diagnosis were estimated with 95% confidence intervals (CIs) to examine changes across ICE quintiles using the most privileged communities (Quintile 5, Q5) as the reference group. Results PRs and RRs showed a higher likelihood of testing and adverse HIV outcomes among persons residing in Q1 (least privileged) communities compared with Q5 (most privileged) across ICE measures. For HIV testing percentages and diagnosis rates, across quintiles, PRs and RRs were consistently greatest for ICErace. For linkage to care and viral suppression, PRs were consistently lower for ICEincome+race. Conclusions We found that poor HIV outcomes and disparities were associated with income, racial, and economic segregation as measured by ICE. These ICE measures contribute to poor HIV outcomes and disparities by unfairly concentrating certain groups (i.e., Black persons) in highly segregated and deprived communities that experience a lack of access to quality, affordable health care. Expanded efforts are needed to address the social/economic barriers that impede access to HIV care among Black persons. Increased partnerships between government agencies and the private sector are needed to change policies that promote and sustain racial and income segregation.

Assessing HIV diagnosis and the social vulnerability index (SVI) by themes (socioeconomic status, household composition and disability, minority status and English proficiency, and housing type and transportation) might help to identify specific social factors contributing to disparities across census tracts with high rates of diagnosed HIV infection in the USA. We examined HIV rate ratios in 2019 using data from CDC’s National HIV Surveillance System (NHSS) for Black/African American, Hispanic/Latino, and White persons aged ≥ 18 years. NHSS data were linked to CDC/ATSDR SVI data to compare census tracts with the lowest SVI (Q1) and highest SVI (Q4) scores. Rates and rate ratios were calculated for 4 SVI themes by sex assigned at birth for age group, transmission category, and region of residence. In the socioeconomic theme analysis, we observed wide within-group disparity among White females with diagnosed HIV infection. In the household composition and disability theme, we observed high HIV diagnosis rates among Hispanic/Latino and White males who lived in the least socially vulnerable census tracts. In the minority status and English proficiency theme, we observed a high percentage of Hispanic/Latino adults with diagnosed HIV infection in the most socially vulnerable census tracts. In the housing type and transportation theme, we observed a high percentage of HIV diagnoses attributed to injection drug use in the most socially vulnerable census tracts. The development and prioritization of interventions that address specific social factors contributing to disparities in HIV across census tracts with high diagnosis rates are critical to reducing new HIV infections in the USA.

Background: Diagnoses of HIV in the United States decreased by 17% in 2020 due to COVID-related disruptions. The extent to which this decrease is attributable to changes in HIV testing versus HIV transmission is unclear. We seek to better understand this issue by analyzing the discrepancy in expected versus observed HIV diagnoses in 2020 among persons who acquired HIV between 2010 and 2019 because changes in diagnosis patterns in this cohort cannot be attributed to changes in transmission. Methods: We developed 3 methods based on the CD4-depletion model to estimate excess missed diagnoses in 2020 among persons with HIV (PWH) infected from 2010 to 2019. We stratified the results by transmission group, sex assigned at birth, race/ethnicity, and region to examine differences by group and confirm the reliability of our estimates. We performed similar analyses projecting diagnoses in 2019 among PWH infected from 2010 to 2018 to evaluate the accuracy of our methods against surveillance data. Results: There were approximately 3100–3300 (approximately 18%) fewer diagnoses than expected in 2020 among PWH infected from 2010 to 2019. Females (at birth), heterosexuals, persons who inject drugs, and Hispanic/Latino PWH missed diagnoses at higher levels than the overall population. Validation and stratification analyses confirmed the accuracy and reliability of our estimates. Conclusions: The substantial drop in number of previously infected PWH diagnosed in 2020 suggests that changes in testing played a substantial role in the observed decrease. Levels of missed diagnoses differed substantially across population subgroups. Increasing testing efforts and innovative strategies to reach undiagnosed PWH are needed to offset this diagnosis gap. These analyses may be used to inform future estimates of HIV transmission during the COVID-19 pandemic.

During 2018, Black or African American (Black) persons accounted for 43% of all new diagnoses of HIV infection in the United States (1). The annual diagnosis rate (39.2 per 100,000 persons) among Black persons was four times the rate among all other racial/ethnic groups combined, indicating a profound disparity in HIV diagnoses (1,2). Community-level social and structural factors, such as social vulnerability, might help explain the higher rate of HIV diagnoses among Black persons. Social vulnerability refers to the potential negative health effects on communities caused by external stresses (3). CDC used National HIV Surveillance System (NHSS)* and Social Vulnerability Index (SVI)† data to examine the association between diagnosed HIV infections and social vulnerability among Black adults aged ≥18 years. Black adults in communities in the highest quartile of SVI were 1.5 times (rate ratio [RR] = 1.5; 95% CI = 1.4-1.6) as likely to receive a diagnosis of HIV infection as were those in communities in the lowest quartile. Because of a history of racial discrimination and residential segregation, some Black persons in the United States reside in communities with the highest social vulnerability (4,5), and this finding is associated with experiencing increased risk for HIV infection. The development and prioritization of interventions that address social determinants of health (i.e., the conditions in which persons are born, grow, live, work, and age), are critical to address the higher risk for HIV infection among Black adults living in communities with high levels of social vulnerability. Such interventions might help prevent HIV transmission and reduce disparities among Black adults.

OBJECTIVE:Social and structural factors, referred to as social determinants of health (SDH), create pathways or barriers to equitable sexual health, and information on these factors can provide critical insight into rates of diseases such as HIV. Our objectives were to describe and identify differences, by race/ethnicity and geography, in SDH among adults with HIV. METHODS:We conducted an ecological study to explore SDH among people with HIV diagnosed in 2017, by race/ethnicity and geography, at the census-tract level in the United States and Puerto Rico. We defined the least favorable SDH as the following: low income (<$40 000 in median annual household income), low levels of education (≥18% of residents have <high school diploma), high levels of poverty (≥19% of residents live below the federal poverty level), unemployment (≥6% of residents in the workface do not have a job), lack of health insurance (≥16% of residents lack health insurance), and vacant housing (≥15% of housing units are vacant). RESULTS:HIV diagnosis rates increased 1.4 to 4.0 times among men and 1.5 to 5.5 times among women as census-tract poverty levels increased, education levels decreased, income decreased, unemployment increased, lack of health insurance increased, and vacant housing increased. Among racial/ethnic groups by region and SDH, we observed higher HIV diagnosis rates per 100 000 population among non-Hispanic Black (49.6) and non-Hispanic White (6.5) adults in the South and among Hispanic/Latino (27.4) adults in the Northeast than in other regions. We observed higher HIV diagnosis rates per 100 000 population among non-Hispanic Black (44.3) and Hispanic/Latino (21.1) adults than among non-Hispanic White (5.1) adults. CONCLUSION:Our findings highlight the importance of SDH in HIV infection and support the need for effective, targeted local interventions to specific populations based on HIV diagnoses and prevalence to prevent infection and reduce racial/ethnic disparities.

Objective People who inject drugs are among the groups most vulnerable to HIV infection. The objective of this study was to describe differences in the geographic distribution of HIV diagnoses and social determinants of health (SDH) among people who inject drugs (PWID) who received an HIV diagnosis in 2017. Methods We used data from the National HIV Surveillance System (NHSS) to determine the counts and percentages of PWID aged ≥18 with HIV diagnosed in 2017. We combined these data with data from the US Census Bureau’s American Community Survey at the census tract level to examine regional, racial/ethnic, and population-area-of-residence differences in poverty status, education level, income level, employment status, and health insurance coverage. Results We observed patterns of disparity in HIV diagnosis counts and SDH among the 2666 PWID with a residential address linked to a census tract, such that counts of HIV diagnosis increased as SDH outcomes became worse. The greatest proportion of PWID lived in census tracts where ≥19% of the residents lived below the federal poverty level, ≥18% of the residents had <high school diploma, the median annual household income was <$40 000, and ≥16% of the residents did not have health insurance or a health coverage plan. Conclusion To our knowledge, our study is the first large-scale, census tract–level study to describe SDH among PWID with diagnosed HIV in the United States. The findings of substantial disparities in SDH among people with HIV infection attributed to injection drug use should be further examined. Understanding the SDH among PWID is crucial to reducing disparities in HIV diagnoses in this population.

OBJECTIVES:To reduce the number of new HIV infections and improve HIV health care outcomes, the social conditions in which people live and work should be assessed. The objective of this study was to describe linkage to HIV medical care by selected demographic characteristics and social determinants of health (SDH) among US adults with HIV at the county level.METHODS:We used National HIV Surveillance System data from 42 US jurisdictions and data from the American Community Survey to describe differences in linkage to HIV medical care among adults aged ≥18 with HIV infection diagnosed in 2017. We categorized SDH variables into higher or lower levels of poverty (where <13% or ≥13% of the population lived below the federal poverty level), education (where <13% or ≥13% of the population had <high school diploma), and health insurance coverage (where <12% or ≥12% of the population lacked health insurance). We calculated prevalence ratios (PRs) and 95% CIs.RESULTS:Of 33 204 adults with HIV infection diagnosed in 2017, 78.4% were linked to HIV medical care ≤1 month after diagnosis. Overall, rates of linkage to care were significantly lower among men and women living in counties with higher versus lower poverty (PR = 0.96; 95% CI, 0.94-0.97), with lower versus higher health insurance coverage (PR = 0.93; 95% CI, 0.92-0.94), and with lower versus higher education levels (PR = 0.97; 95% CI, 0.96-0.98).CONCLUSIONS:Increasing health insurance coverage and addressing economic and educational disparities would likely lead to better HIV care outcomes in these areas.

Purpose: HIV disparities continue to persist in the southern United States and among some populations. Early HIV diagnosis, prompt linkage to care, and viral suppression among persons with HIV in the South, in particular the Deep South, are critical to reduce disparities and achieve national prevention goals.Methods: Estimated annual percent changes were calculated to assess trends during 2015-2019 in per-centage distributions for stage of disease at the time of diagnosis, linkage to HIV medical care, and viral suppression.Results: Among 95,488 persons with HIV diagnosed in the South (Deep South: 81,848; Other South:13,640), the overall percentage that received a diagnosis classified as stage 0 increased 9.0%, stages 1-2 increased 1.8%, linkage to HIV care increased 2.9%, and viral suppression increased 5.9%. Changes in care outcomes among American Indian/Alaska Native persons and persons with infection attributed to injection drug use were minimal.Conclusions: To reach the goals of Ending the HIV Epidemic (EHE) and other federal initiatives, effort s need to focus on prevention and care among persons residing in the South. Addressing factors such as stigma and discrimination and elimination of barriers to HIV testing, care, and treatment are needed to effectively address these disparities in HIV-related care outcomes. Published by Elsevier Inc.