Social Determinants of Health among Adults with Diagnosed HIV Infection, 2018: Commentary

HIV Surveillance Commendtary


HIV continues to disproportionately affect various pop­ulations in the United States. To accelerate action to end the HIV epidemic, the U.S. Department of Health and Human Services (HHS) has developed a plan to reduce new HIV infections in the United States–the Ending the HIV Epidemic in the U.S. (EHE) initiative [1]. Differences in HIV burden, by sex, race/ethnicity (i.e., Blacks/African Americans, Hispanics/Latinos, and whites) and transmission category, have long been highlighted through HIV surveillance data in the United States. Factors other than individual attributes related to sex, race/ethnicity, or behavioral risk factors contribute to disparities and may be partly explained through a better understanding of the social determinants that affect the health of populations.

The term social determinants of health (SDH) refers to the overlapping social structures and economic sys­tems (e.g., social environment, physical environment, health services, and structural and societal factors) that are responsible for most health inequities [2]. Stratify­ing public health data by key SDH is useful in moni­toring health inequities. Addressing SDH also helps to quantify health differences between populations or geographic areas and can provide insight for identifying popula­tions or areas that may benefit from HIV testing, pre­vention, and treatment initiatives.

The Centers for Disease Control and Prevention (CDC) incorporates geocoding of HIV surveillance data by state and local HIV surveillance programs, with the purpose to capture, store, analyze, and display geocoded HIV surveillance data along with SDH indicators that may affect HIV transmission. HIV surveillance data are geocoded to the census tract level for addresses of residence at the time of diagnosis and linked at the census tract level to SDH indicator variable data from the U.S. Census Bureau’s American Community Survey (ACS). Using census tract-level surveillance data increases CDC’s ability to assess the geographic distribution of HIV, the social determinants associated with HIV, and the relationship of HIV to other diseases and health care resources in a defined area. Addressing the SDH that adversely affect health outcomes may advance efforts in reducing disparities in HIV diagnosis rates between populations.

This surveillance supplemental report presents data on persons aged 18 years and older with HIV infection diagnosed in 2018 and reported to the National HIV Surveillance System (NHSS) through December 2019. Data were limited to persons aged 18 years and older to more accurately represent the population from which the SDH indicator variables were collected by the U.S. Census Bureau’s ACS. The numbers, percentages, and rates of diagno­ses of HIV infection were based on data reported to CDC from the 50 states, District of Columbia, and Puerto Rico after the jurisdictions geocoded cases to the census tract level, linked to ACS estimates, and transmitted SDH information to CDC on cases diag­nosed during 2018.

The SDH data presented in this report are the result of the linkage of geocoded HIV diagnosis data (at the census tract level) to SDH indicator variables from the 2014–2018 ACS and are based on where the person was living at the time of diagnosis. The following are the measures for the 5 SDH indicators presented in this report: federal poverty status, education level, median household income, health insurance coverage, and Gini index.  

Report Changes

  • New, digital format that includes figures.
  • Gini index added to measure income inequality.
  • Viral suppression within 6 months of HIV diagnosis added (Tables 10a–10d).
  • Data included in the previous surveillance supplemental report, Part B: County-level Social Determinants of Health, Selected Care Outcomes, and Diagnosed HIV Infection 41 States and the District of Columbia, are no longer included.
  • Special focus profile section added that addresses health disparities along with income inequality and factors for special consideration in addressing health disparities.
  • Census tract-level, ACS SDH data (for the 50 states, the District of Columbia, and Puerto Rico) are displayed in supplemental tables (S1–S5). These data were obtained directly from the U.S. Census Bureau’s 2014–2018 ACS estimates.
  • Census tract-level diagnoses of HIV infection, by race/ethnicity, selected characteristics, and selected SDH are displayed in appendix tables (A1–B3).