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Relationship of Racial Residential Segregation to Newly Diagnosed Cases of HIV among Black Heterosexuals in US Metropolitan Areas, 2008–2015

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Abstract

Social science and public health literature has framed residential segregation as a potent structural determinant of the higher HIV burden among black heterosexuals, but empirical evidence has been limited. The purpose of this study is to test, for the first time, the association between racial segregation and newly diagnosed heterosexually acquired HIV cases among black adults and adolescents in 95 large US metropolitan statistical areas (MSAs) in 2008–2015. We operationalized racial segregation (the main exposure) using Massey and Denton’s isolation index for black residents; the outcome was the rate of newly diagnosed HIV cases per 10,000 black adult heterosexuals. We tested the relationship of segregation to this outcome using multilevel multivariate models of longitudinal (2008–2015) MSA-level data, controlling for potential confounders and time. All covariates were lagged by 1 year and centered on baseline values. We preliminarily explored mediation of the focal relationship by inequalities in education, employment, and poverty rates. Segregation was positively associated with the outcome: a one standard deviation decrease in baseline isolation was associated with a 16.2% reduction in the rate of new HIV diagnoses; one standard deviation reduction in isolation over time was associated with 4.6% decrease in the outcome. Exploratory mediation analyses suggest that black/white socioeconomic inequality may mediate the relationship between segregation and HIV. Our study suggests that residential segregation may be a distal determinant of HIV among black heterosexuals. The findings further emphasize the need to address segregation as part of a comprehensive strategy to reduce racial inequities in HIV.

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Acknowledgments

The following grants supported this project: Metropolitan Trajectories of HIV Epidemics, Drug Use, and Responses in US Key Populations (DA037568; PIs: Cooper, Friedman, and Stall); Center for AIDS Research at Emory University (P30AI050409; PI: Del Rio); and Center for Drug Use and HIV Research (P30 DA11041; PI Sherry Deren).

We express our gratitude to the US Centers for Disease Control and Prevention for sharing the following databases: the HIV Counseling and Testing System database and the National HIV Surveillance System database.

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.

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Authors and Affiliations

  1. Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Umedjon Ibragimov, Stephanie Beane & Hannah L. F. Cooper

  2. Division of Infectious Diseases, School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA

    Adaora A. Adimora

  3. National Development and Research Institutes Inc, New York, NY, USA

    Samuel R. Friedman, Leslie Williams & Barbara Tempalski

  4. Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Ron Stall

  5. Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health, Columbia University, New York, NY, USA

    Gina Wingood

  6. HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA

    H. Irene Hall & Anna Satcher Johnson

Authors
  1. Umedjon Ibragimov
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  2. Stephanie Beane
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  3. Adaora A. Adimora
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  4. Samuel R. Friedman
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  5. Leslie Williams
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  6. Barbara Tempalski
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  9. H. Irene Hall
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  10. Anna Satcher Johnson
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  11. Hannah L. F. Cooper
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Correspondence to Umedjon Ibragimov.

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Ibragimov, U., Beane, S., Adimora, A.A. et al. Relationship of Racial Residential Segregation to Newly Diagnosed Cases of HIV among Black Heterosexuals in US Metropolitan Areas, 2008–2015. J Urban Health 96, 856–867 (2019). https://doi.org/10.1007/s11524-018-0303-1

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  • DOI: https://doi.org/10.1007/s11524-018-0303-1

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