Which County-Level Factors Influence Latino HIV Disparities?

While they account for 18% of the US population, Latinos/Hispanics make up 1 in 4 HIV cases, leading researchers to analyze county-level factors accounting for this disparity. What they found was that counties that are more rural, have fewer Latinos, or have lower HIV prevalence rates among non-Latino whites were more likely to have greater disparities.

For example, counties with a smaller proportion of Latinos faced a Latino HIV prevalence rate that was nearly 4 times that of whites. When there were higher proportions of Latinos, the prevalence rate among Latinos dropped to 1.5 times that of whites.

Overall, among the 775 counties accounting for 192,045 Latinos and 234,013 whites, Latinos had a 2.5 higher median rate of HIV cases.

Across the counties analyzed in the study, the researchers found that, after controlling for urbanicity and geographic regions, those with characteristics specific to Latinos had greater disparities, which became more evident as the percent of Latinos below poverty, percent of Latinos who are Puerto Rican, and percent who are not English proficient increased.

In total, 11 of 41 county-level factors analyzed were found to have a significant effect, whether positive or negative, on Latino disparities.

Counties that had more robust community support, as shown by more prevalent social association rates, less housing issues, and a larger proportion of white than Latino population, demonstrated lower disparities. According to the researchers, this is in line with previous research indicating that community environment, organization, and social support are all key factors in facilitating or hindering Latinos’ ability to access and adhere to HIV care services.

“Generally, disparities varied inversely with urbanicity, regardless of the total poverty percentage of the county,” noted the researchers. “Counties with total percent in poverty less than 15% generally had the largest PRR, across all levels of urbanicity, compared to counties with higher percentages of poverty. As levels of percent in poverty increase, HIV disparities between Latinos and NL-Whites appear to remain stable; this was borne out by a non-significant interaction between urbanicity, poverty, and race/ethnicity.”

In nearly every county, Latinos had higher rates of HIV than whites, with 95% of counties having a prevalence rate ratio (PRR) ratio of >1. Six percent of these counties had a Latino to NL-White PRR of more than 10, and only 6% of counties had PRR rates below 1.

Among the counties, those in the Northeast—the only region with no counties having a PRR <1—had the highest median PRR (6.6), followed by the Midwest (PRR = 3.2), the South (PRR = 2.1), and the South (PRR = 1.3).

Reference

Benbow N, Aaby D, Rosenberg E, Brown C. County-level factors affecting Latino HIV disparities in the United States. PLoS One. Published online August 12, 2020. doi: 10.1371/journal.pone.0237269.