Comparing neighborhood and state contexts for women living with and without HIV: understanding the Southern HIV epidemic

ABSTRACT

In the South, people living with HIV experience worse health outcomes than in other geographic regions, likely due to regional political, structural, and socioeconomic factors. We describe the neighborhoods of women (n = 1,800) living with and without HIV in the Women’s Interagency HIV Study (WIHS), a cohort with Southern sites in Chapel Hill, NC; Atlanta, GA; Birmingham, AL; Jackson, MS; and Miami, FL; and non-Southern sites in Brooklyn, NY; Bronx, NY; Washington, DC; San Francisco, CA; and Chicago, IL. In 2014, participants’ addresses were geocoded and matched to several administrative data sources. There were a number of differences between the neighborhood contexts of Southern and non-Southern WIHS participants. Southern states had the lowest income eligibility thresholds for family Medicaid, and consequently higher proportions of uninsured individuals. Modeled proportions of income devoted to transportation were much higher in Southern neighborhoods (Location Affordability Index of 28–39% compared to 16–23% in non-Southern sites), and fewer participants lived in counties where hospitals reported providing HIV care (55% of GA, 63% of NC, and 76% of AL participants lived in a county with a hospital that provided HIV care, compared to >90% at all other sites). Finally, the states with the highest adult incarceration rates were all in the South (per 100,000 residents: AL 820, MS 788, GA 686, FL 644). Many Southern states opted not to expand Medicaid, invest little in transportation infrastructure, and have staggering rates of incarceration. Resolution of racial and geographic disparities in HIV health outcomes will require addressing these structural barriers.

KEYWORDS:

• HIV
• neighborhood
• transportation
• women
• public policy

Acknowledgements

Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH).

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Joseph J. Eron http://orcid.org/0000-0002-4938-0644

Additional information

Funding

This work was supported in part by the National Institutes of Health [U01 AI103390 and K24 HD059358]. WIHS (Principal Investigators): UAB-MS WIHS (Mirjam-Colette Kempf and Deborah Konkle-Parker) [grant number U01-AI-103401]; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood) [grant number U01-AI-103408]; Bronx WIHS (Kathryn Anastos and Anjai Sharma) [grant number U01-AI-035004]; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson) [grant number U01-AI-031834]; Chicago WIHS (Mardge Cohen and Audrey French) [grant number U01-AI-034993]; Metropolitan Washington WIHS (Seble Kassaye) [grant number U01-AI-034994]; Miami WIHS (Margaret Fischl and Lisa Metsch) [grant number U01-AI-103397]; UNC WIHS (Adaora Adimora) [grant number U01-AI-103390]; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien) [grant number U01-AI-034989]; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub) [grant number U01-AI-042590]; Southern California WIHS (Joel Milam) [grant number U01-HD-032632] (WIHS I – WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA). UL1-TR000454 (Atlanta CTSA), and P30AI50410 (UNC CFAR).