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Identifying Which Place Characteristics are Associated with the Odds of Recent HIV Testing in a Large Sample of People Who Inject Drugs in 19 US Metropolitan Areas

Abstract

This exploratory analysis investigates relationships of place characteristics to HIV testing among people who inject drugs (PWID). We used CDC’s 2012 National HIV Behavioral Surveillance (NHBS) data among PWID from 19 US metropolitan statistical areas (MSAs); we restricted the analytic sample to PWID self-reporting being HIV negative (N = 7477). Administrative data were analyzed to describe the 1. Sociodemographic Composition; 2. Economic disadvantage; 3. Healthcare Service/Law enforcement; and 4. HIV burden of the ZIP codes, counties, and MSAs where PWID lived. Multilevel models tested associations of place characteristics with HIV testing. Fifty-eight percent of PWID reported past-year testing. MSA-level per capita correctional expenditures were positively associated with recent HIV testing among black PWID, but not white PWID. Higher MSA-level household income and imbalanced sex ratios (more women than men) in the MSA were associated with higher odds of testing. HIV screening for PWID is suboptimal (58%) and needs improvement. Identifying place characteristics associated with testing among PWID can strengthen service allocation and interventions in areas of need to increase access to HIV testing.

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Notes

  1. 1.

    The isolation index measures the extent to which minority members are exposed only to one another, and was calculated per Massey and Denton [32]. The isolation index varies from 0 (no isolation) to 100 (complete isolation).

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Acknowledgements

This research was supported by two Grants from the National Institutes of Health: “Place Characteristics & Disparities in HIV in IDUS: A Multilevel Analysis of NHBS” (DA035101; Cooper, PI) and, “Metropolitan Trajectories of HIV Epidemics and Responses in US Key Populations” (DA037568; Cooper, Friedman, & Stall, PIs). It was also supported by the Centers and Disease Control and Prevention, and the National HIV Behavioral Surveillance System Study Group: Atlanta, GA: Jennifer Taussig, Shacara Johnson, Jeff Todd; Baltimore, MD: Colin Flynn, Danielle German; Boston, MA: Debbie Isenberg, Maura Driscoll, Elizabeth Hurwitz; Chicago, IL: Nikhil Prachand, Nanette Benbow; Dallas, TX: Sharon Melville, Richard Yeager, Jim Dyer, Alicia Novoa; Denver, CO: Mark Thrun, Alia Al-Tayyib; Detroit, MI: Emily Higgins, Eve Mokotoff, Vivian Griffin; Houston, TX: Aaron Sayegh, Jan Risser, Hafeez Rehman; Los Angeles, CA: Trista Bingham, Ekow Kwa Sey; Miami, FL: Lisa Metsch, David Forrest, Dano Beck, Gabriel Cardenas; Nassau-Suffolk, NY: Chris Nemeth, Lou Smith, Carol-Ann Watson; New Orleans, LA: William T. Robinson, DeAnn Gruber, Narquis Barak; New York City, NY: Alan Neaigus, Samuel Jenness, Travis Wendel, Camila Gelpi-Acosta, Holly Hagan; Newark, NJ: Henry Godette, Barbara Bolden, Sally D’Errico; Philadelphia, PA: Kathleen A. Brady, Althea Kirkland, Mark Shpaner; San Diego, CA: Vanessa Miguelino-Keasling, Al Velasco; San Francisco, CA: H. Fisher Raymond; San Juan, PR: Sandra Miranda De Leo´n, Yadira Rolo´n-Colo´n; Seattle, WA: Maria Courogen, Hanne Thiede, Richard Burt; St Louis, MO: Michael Herbert, Yelena Friedberg, Dale Wrigley, Jacob Fisher; Washington, DC: Marie Sansone, Tiffany West-Ojo, Manya Magnus, Irene Kuo; Behavioral Surveillance Team. We also thank the men and women who participated in NHBS and the staff at all NHBS sites.

Author information

Correspondence to Barbara Tempalski.

Ethics declarations

Conflict of interest

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Ethical Approval

Each author has contributed to the conception and design of the work, the acquisition of data or the analysis of the data in a manner substantial enough to take public responsibility for it. In addition, each author believes that the paper represents valid work and has reviewed the final version of the manuscript and approves it for publication. The findings in this paper have not been published and are not being considered elsewhere for publication.

Ethics

Emory University’s Institutional Review Board (IRB) approved this study’s protocols; each NHBS site’s IRB approved the NHBS protocol. CDC reviewed and approved the protocol as non-engaged research.

Additional information

National HIV Behavioral Surveillance Study Group author names are listed in Acknowledgements.

Appendices

Appendix 1

See Table 7.

Table 7 Results of three geographic-scale specific, multivariable multilevel models regressing the odds of past-year HIV testing on individual race/ethnicity and place-based covariates in a sample of self-reported HIV-negative people who inject drugs (PWID; N = 7477), drawn from the 2012 National HIV Behavioral Surveillance. Hierarchical generalized linear models were applied to account for place-based clustering

Appendix 2: Characteristics Among Self-Reported HIV-Negative PWID (N = 7477), Drawn from the 2012 Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance

Description of the Places Where PWID Lived

Sociodemographic composition characteristics: On average, PWID lived in ZIP codes where 26.7% (SD = 23.4) of PWID are white, 38.9% (SD = 31.7) black and 24.8% (SD = 23.9) Latino. MSA-level average black residential isolation index was 44.8% (SD = 20.6) and the average Latino isolation index was 37.3% (SD = 16.8) (Appendix A).

Economic disadvantage characteristics: The mean ZIP code poverty rate for PWID was 28.4% (SD = 11.4); in comparison, the mean county-level poverty rate was 18.8% (SD = 5.2), and the mean MSA-level poverty rate 14.4% (SD = 4.3). On average PWID lived in ZIP codes with a median household income of $40,909.00, in counties where the median income was $54,817.00, and in MSAs where the median income was $66,668.00.

Healthcare Service/Law Enforcement intervention characteristics: In this sample, the mean ZIP code distance (i.e., 3 mile radius) for spatial access to substance use disorder treatment facilities was 1.8 (SD = 2.2). On our dichotomous measures of spatial access to other health services for PWID, we found that 77.4% of PWID lived in ZIP codes where spatial access to HIV testing sites > 0 (i.e., there was ≥ 1 testing site within 3 miles of the ZIP’s centroid), 63% had some spatial access to an MTP, and 48.8% had some spatial access to an SSP.

On average, PWID lived in counties where 22.0% (SD = 8.7) of residents were without health insurance, and where 16.9% (SD = 21.1) of residents lived in medically underserved areas. On average, PWID were located in counties where arrest rates for hard drug possession were 3.6 per 1000 population (SD = 3.1), and in MSAs where arrest rates were 2.8 per 1000 population (SD = 1.4).

On average, PWID lived in MSAs that spent $333.60 per capita on police (SD = 95.1), $97.60 per capita on corrections (SD = 44.7), and $163.60 per capita on health care (SD = 170.0).

HIV burden characteristics: On average, PWID lived in MSAs where annual AIDS-related mortality rates among PWID were 1.37 per 1000 PWID (SD = 1.8) and where annual AIDS diagnoses among PWID were 0.89 per 1000 PWID (SD = 0.9).

See Table 8.

Table 8 Characteristics among self-reported HIV-negative PWID (N = 7477), drawn from the 2012 Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance

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Tempalski, B., Cooper, H.L.F., Kelley, M.E. et al. Identifying Which Place Characteristics are Associated with the Odds of Recent HIV Testing in a Large Sample of People Who Inject Drugs in 19 US Metropolitan Areas. AIDS Behav 23, 318–335 (2019) doi:10.1007/s10461-018-2217-z

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Keywords

  • Place characteristics
  • HIV testing
  • People who inject drugs
  • National HIV Behavioral Surveillance
  • US metropolitan statistical areas