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AIDS Care. 2018 Nov;30(11):1360-1367. doi: 10.1080/09540121.2018.1492696. Epub 2018 Jul 1.

Comparing neighborhood and state contexts for women living with and without HIV: understanding the Southern HIV epidemic.

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a Department of Epidemiology and Biostatistics , Indiana University School of Public Health-Bloomington , Bloomington , IN , USA.
b Department of Epidemiology , UNC Gillings School of Global Public Health , Chapel Hill , NC , USA.
c Department of Medicine, Division of Infectious Diseases , UNC School of Medicine , Chapel Hill , NC , USA.
d Department of Epidemiology & Population Health , Albert Einstein College of Medicine and Montefiore Medical Center , New York , NY , USA.
e Department of Clinical Pharmacy , University of California , San Francisco , CA , USA.
f Department of Medicine , Cook County Health and Hospital System and Rush University , Chicago , IL , USA.
g Department of Medicine , Georgetown University , Washington , DC , USA.
h Department of Medicine, Division of Infectious Disease , University of Mississippi Medical Center , Jackson , MS , USA.
i Department of Sociomedical Sciences , Mailman School of Public Health , New York , NY , USA.
j Department of Community Health Sciences , State University of New York (SUNY) Downstate Medical Center School of Public Health , Brooklyn , NY , USA.


In the South, people living with HIV experience worse health outcomes than in other geographic regions, likely due to regional political, structural, and socioeconomic factors. We describe the neighborhoods of women (n = 1,800) living with and without HIV in the Women's Interagency HIV Study (WIHS), a cohort with Southern sites in Chapel Hill, NC; Atlanta, GA; Birmingham, AL; Jackson, MS; and Miami, FL; and non-Southern sites in Brooklyn, NY; Bronx, NY; Washington, DC; San Francisco, CA; and Chicago, IL. In 2014, participants' addresses were geocoded and matched to several administrative data sources. There were a number of differences between the neighborhood contexts of Southern and non-Southern WIHS participants. Southern states had the lowest income eligibility thresholds for family Medicaid, and consequently higher proportions of uninsured individuals. Modeled proportions of income devoted to transportation were much higher in Southern neighborhoods (Location Affordability Index of 28-39% compared to 16-23% in non-Southern sites), and fewer participants lived in counties where hospitals reported providing HIV care (55% of GA, 63% of NC, and 76% of AL participants lived in a county with a hospital that provided HIV care, compared to >90% at all other sites). Finally, the states with the highest adult incarceration rates were all in the South (per 100,000 residents: AL 820, MS 788, GA 686, FL 644). Many Southern states opted not to expand Medicaid, invest little in transportation infrastructure, and have staggering rates of incarceration. Resolution of racial and geographic disparities in HIV health outcomes will require addressing these structural barriers.


HIV; neighborhood; public policy; transportation; women

[Available on 2019-11-01]
[Indexed for MEDLINE]

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