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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Sheehan, Diana M; Trepka, Mary Jo; Fennie, Kristopher P et al. (2015) Rate of new HIV diagnoses among Latinos living in Florida: disparities by country/region of birth. AIDS Care 27:507-11
Sheehan, Diana M; Trepka, Mary Jo; Dillon, Frank R (2015) Latinos in the United States on the HIV/AIDS care continuum by birth country/region: a systematic review of the literature. Int J STD AIDS 26:12-Jan
Trepka, Mary Jo; Fennie, Kristopher P; Pelletier, Valerie et al. (2014) Migration patterns among Floridians with AIDS, 1993-2007: implications for HIV prevention and care. South Med J 107:531-9
Trepka, Mary Jo; Fennie, Kristopher P; Sheehan, Diana M et al. (2014) Late HIV diagnosis: Differences by rural/urban residence, Florida, 2007-2011. AIDS Patient Care STDS 28:188-97
Trepka, Mary Jo; Niyonsenga, Theophile; Maddox, Lorene M et al. (2013) Rural AIDS diagnoses in Florida: changing demographics and factors associated with survival. J Rural Health 29:266-80
Niyonsenga, Theophile; Trepka, Mary Jo; Lieb, Spencer et al. (2013) Measuring socioeconomic inequality in the incidence of AIDS: rural-urban considerations. AIDS Behav 17:700-9
Trepka, Mary Jo; Niyonsenga, Theophile; Maddox, Lorene et al. (2013) Community poverty and trends in racial/ethnic survival disparities among people diagnosed with AIDS in Florida, 1993-2004. Am J Public Health 103:717-26
Trepka, Mary Jo; Maddox, Lorene M; Lieb, Spencer et al. (2011) Utility of the National Death Index in ascertaining mortality in acquired immunodeficiency syndrome surveillance. Am J Epidemiol 174:90-8
Ford, Marvella E; Havstad, Suzanne L; Fields, Maya E et al. (2008) Effects of baseline comorbidities on cancer screening trial adherence among older African American men. Cancer Epidemiol Biomarkers Prev 17:1234-9
Ford, Marvella E; Havstad, Suzanne; Vernon, Sally W et al. (2006) Enhancing adherence among older African American men enrolled in a longitudinal cancer screening trial. Gerontologist 46:545-50

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