Social Determinants of Health among Adults with Diagnosed HIV Infection, 2019: Commentary


HIV continues to disproportionately affect many populations in the United States. Data in this report may be used to accelerate action to reach disproportionately affected populations and achieve national goals, including the Department of Health and Human Services (HHS) core indicators [1, 2], Healthy People 2030 [3], the National HIV Strategic Plan for the United States: A Roadmap to End the Epidemic 2021–2025 (NHSP) [4], and the United States—Ending the HIV Epidemic in the U.S. (EHE) initiative [5]. HIV surveillance data have highlighted differences in HIV burden by sex at birth, race/ethnicity, and transmission category in the United States. Factors other than these (i.e., social determinants of health) contribute to disparities, and a better understanding of the social determinants that affect the health of populations can be beneficial.

The term social determinants of health (SDH) refers to the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems that are responsible for most health inequities [6], including the disproportionate effect of HIV on certain populations. Achieving equitable health will require focusing on factors associated with disparities and directing resources to disproportionately affected populations and geographical regions. This approach will improve the health of all persons.

Stratifying public health data by key SDH, such as income and health insurance coverage, is useful for monitoring health inequities. Addressing SDH makes it possible to measure and identify 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.

For this report, the Centers for Disease Control and Prevention (CDC) uses geocoded HIV surveillance data reported by state and local HIV surveillance programs that have been linked with SDH indicator variables on factors that may affect HIV transmission. HIV surveillance data are geocoded to the census tract level by address of residence at the time of diagnosis and then linked to census tract-level SDH 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 healthcare resources in a defined area. Addressing SDH that adversely affect health outcomes may advance efforts to reduce disparities in HIV diagnosis rates among populations and areas.

This surveillance supplemental report presents data on persons aged 18 years and older (adults) with HIV infection diagnosed in 2019 and reported to the National HIV Surveillance System (NHSS) through June 2021. Data were limited to persons aged 18 years and older to align with the population in the ACS from which SDH indicator variables were collected. Numbers, percentages, and rates of diagnoses of HIV infection were based on data reported from the 50 states, the 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 (after personal identifiers were removed) diagnosed during 2019.

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 2015–2019 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

  • The National SDH Profile includes sections on 1) Gini index and 2) absolute and relative disparity measures to examine disparities in diagnoses of HIV infection within population groups by sex at birth, age group, and race/ethnicity.
  • Special Focus Profiles section includes disparity measures for American Indian/Alaska Native, Asian, and multiracial persons.
  • Tables now include additional geographic stratifications (region and population), and all race/ethnicity tables include all racial/ethnic groups.