SDOH Lead to Care Access Issues and Poor HIV Health Outcomes

There is a direct connection between social determinants of health (SDOH), like poverty and lack of health insurance, and care access issues and poor health outcomes for HIV patients, according to a study published recently in Public Health Reports.

Researchers found that rates of access to HIV medical care were lowest among men and women living in areas with high poverty rates, those without health insurance, and those with minimal education. The findings point to a growing need to address social determinants of health, particularly among marginalized populations.

About 1.2 million people in the US had HIV at the end of 2018, according to the Centers for Disease Control & Prevention (CDC). Of those 1.2 million people, one in seven did not even know they had HIV.

Black adolescents and adults accounted for 42 percent of all new HIV diagnoses in the US in 2018, and Hispanic/Latinx adults accounted for 27 percent, the CDC reported.

In 2019, HHS announced its Ending the HIV Epidemic in the U.S. (EHE) plan, aimed at coordinating prevention, treatment, and diagnosis developments, according to HIV.gov.

The EHE plan intends to reduce new HIV infections by 75 percent by 2025, and by at least 90 percent by 2030. The US has seen significant efforts by the government to curb the HIV epidemic in the past few years, but social determinants of health remain a driving factor in new infections.

Study researchers analyzed National HIV Surveillance System (NHSS) data from 41 states and the District of Colombia along with 2017 results from the American Community Survey. The research team centered its analysis on poverty levels, education, and health insurance coverage to identify a linkage between SDOH and access to medical care within one month of diagnosis.

Over 33,000 people in the 42 studied jurisdictions received an HIV diagnosis in 2017 and were included in the analysis. Over 75 percent of those people gained access to care less than one month after diagnosis. Care linkage was lowest among men between the ages of 18 and 34.

Participants who lived in regions with higher rates of health insurance, less poverty, and more education were more likely to access care within one month compared to underinsured areas with more poverty and less education.

“These findings may be attributed to factors such as lack of social support services, socioeconomic instability, and limited public transportation and highlight that structural and societal factors such as social and physical environments, and availability, cost of, and access to health services, may create barriers to HIV care,” the study stated.

“Identifying the limitations to accessing care and the [SDOH] factors that may contribute to these limitations is critical and will provide insight on additional factors associated with lower rates of linkage to care in the United States.”

HHS recently announced the launch of The HIV Challenge, a competition aimed at reducing HIV-related stigma. Participants are tasked with developing innovative ways to increase the use of pre-exposure prophylaxis medication (PrEP) and antiretroviral therapy (ART) among people who are at a high risk for HIV.

“The HIV Challenge will support efforts of local communities to develop and test approaches to reduce HIV-related stigma and increase the use of prevention and treatment options to decrease HIV disparities and health inequities among racial and ethnic minority populations nationally,” RADM Felicia Collins, MD, director of the Office of Minority Health and deputy assistant secretary for minority health, explained in an HHS press release.