Despite highly active antiretroviral therapy being widely available for over 10 years, African Americans have not benefited from improved survival with human immunodeficiency virus (HIV) infection to the same extent as non-Hispanic whites. Survival among African Americans infected with HIV is substantially lower than that among non-Hispanic whites. Our goal is to estimate the role of the contextual factors of community deprivation, segregation, and rural residence in explaining the survival disadvantage of African Americans and characterize the extent to which the factors change between the time of diagnosis with acquired immune deficiency syndrome (AIDS) and death. We have five specific aims: 1) estimate the effect of community-level deprivation and rural residence on racial disparities in HIV survival over time;2) estimate the effect of racial segregation on HIV survival;3) characterize changes in community-level socioeconomic status between the time of AIDS diagnosis and death; 4) compare the degree of community racial segregation between the time of AIDS diagnosis and death;and 5) characterize patterns and predictors of rural to urban migration between AIDS diagnosis and death. We will be conducting a retrospective cohort study of Florida residents diagnosed with AIDS from 1993-2006. Surveillance records from the Florida Department of Health HIV/AIDS Reporting System will be matched with Florida Vital Records and National Death Index records to determine survival status. Surveillance records will be merged with zip-code level socioeconomic data and city level segregation indices from the 2000 U.S. Census and county level health care resource and rural/urban classification data from the Health Resources and Services Administration Area Resource Files. Survival analysis using Cox Proportional Hazards and multilevel models will be conducted. A better understanding of the contribution of contextual factors associated with decreased survival among African Americans can lay the necessary groundwork to guide intervention studies and policy changes to improve survival among African Americans. This supports the National Center for Minority Health and Health Disparities mission to """"""""reduce and ultimately eliminate health disparities.""""""""

Public Health Relevance

Among people infected with the human immunodeficiency virus, African Americans have a significantly shorter survival time than non-Hispanic whites. The goal of this study is to examine the role of factors such as socioeconomic status, segregation, and rural residence in causing this survival disadvantage.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Special Emphasis Panel (ZMD1-PA (R4))
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Alvidrez, Jennifer L
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Florida International University
Public Health & Prev Medicine
Schools of Public Health
United States
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Trepka, Mary Jo; Fennie, Kristopher P; Sheehan, Diana M et al. (2016) Racial-ethnic differences in all-cause and HIV mortality, Florida, 2000-2011. Ann Epidemiol 26:176-82.e1
Trepka, Mary Jo; Sheehan, Diana M; Fennie, Kristopher P et al. (2016) Completeness of HIV reporting on death certificates for Floridians reported with HIV infection, 2000-2011. AIDS Care 28:98-103
Fennie, K P; Trepka, M J; Maddox, L M et al. (2016) Comparison of Individual and Area Level Factors Between HIV-Infected Cisgender and Transgender Individuals in Florida (2006-2014). AIDS Behav 20:2186-91
Sheehan, Diana M; Trepka, Mary Jo; Fennie, Kristopher P et al. (2016) Black-White Latino Racial Disparities in HIV Survival, Florida, 2000-2011. Int J Environ Res Public Health 13:ijerph13010009
Sheehan, Diana M; Trepka, Mary Jo; Fennie, Kristopher P et al. (2016) Individual and Neighborhood Determinants of Late HIV Diagnosis Among Latinos, Florida, 2007-2011. J Immigr Minor Health :
Sheehan, Diana M; Trepka, Mary Jo; Fennie, Kristopher P et al. (2016) Racial/ethnic disparities in delayed HIV diagnosis among men who have sex with men, Florida, 2000-2014. AIDS Care :1-8
Sheehan, Diana M; Trepka, Mary Jo; Fennie, Kristopher P et al. (2016) Neighborhood Latino ethnic density and mortality among HIV-positive Latinos by birth country/region, Florida, 2005-2008. Ethn Health 21:268-83
Trepka, Mary Jo; Niyonsenga, Theophile; Fennie, Kristopher P et al. (2015) Sex and Racial/Ethnic Differences in Premature Mortality Due to HIV: Florida, 2000-2009. Public Health Rep 130:505-13
Lutfi, Khaleeq; Trepka, Mary Jo; Fennie, Kristopher P et al. (2015) Racial residential segregation and risky sexual behavior among non-Hispanic blacks, 2006-2010. Soc Sci Med 140:95-103
Sheehan, Diana M; Trepka, Mary Jo; Fennie, Kristopher P et al. (2015) Individual and neighborhood predictors of mortality among HIV-positive Latinos with history of injection drug use, Florida, 2000-2011. Drug Alcohol Depend 154:243-50

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