In 2017, Miami-Dade County had the highest rate of new HIV diagnoses and the highest HIV prevalence rate among adults and adolescents in the country—according to the Center for Disease Control and Prevention’s (CDC) 2017 HIV Surveillance Report. In the same year, there were 28,055 people living with HIV in Miami-Dade.

A new study published in the August issue of the Journal of Racial and Ethnic Health Disparities has found that social determinants of health, such as economic stability, education, and health and healthcare, were associated with an increased number of people in Miami-Dade who live with uncontrolled HIV, also known as being out of treatment or with a detectable HIV viral load. 

“The study suggests that poverty, lack of education, and being uninsured have detrimental effects on achieving HIV control for people who live with HIV,” said Dayana Rojas, Ph.D., M.P.H., manager of research support at the Miller School of Medicine's Department of Health Sciences, under an initiative funded by the AIDS Healthcare Foundation’s (AHF) Global Public Health Institute at the University of Miami.  

Nationally, Miami-Dade had the highest HIV prevalence rate for Black/African American males, the highest rate of new diagnoses among Black/African American females, the second-highest rate for Hispanics, the highest rate of diagnoses among white males, and the highest prevalence for white females—according to the 2017 CDC report.   

With this knowledge, experts in this cross-sectional study investigated the association between the number of persons with uncontrolled HIV in Miami Dade and social determinants of health, including economic stability, education, social and community context, health and healthcare, and neighborhood and built environment. The study cohort included people living with HIV in 88 Miami-Dade County ZIP codes who were 15 years of age and older with uncontrolled HIV.

Findings specifically showed that 41 percent of people living with HIV in Miami-Dade in 2017 had uncontrolled HIV. Economic stability, education, and health and healthcare determinants had a significant impact on increasing the number of people living with uncontrolled HIV.

According to the study, the most remarkable overrepresentation occurred among Black/African Americans who account for 18.2 percent of the population in the county, while they represented 42 percent of the population of people who live with HIV and 54 percent of the population with uncontrolled HIV. The overrepresentation of Blacks among people who live with HIV is about 170 percent, whereas the overrepresentation of Blacks among people who live with uncontrolled HIV is about 205 percent.

One of the more interesting findings was that living in low socioeconomic status neighborhoods, having low education and/or lack of health insurance, does not have a negative impact on HIV control in non-Hispanic Whites, as it does in African Americans. Race is thus a risk factor for African Americans and a protective factor for non-Hispanic Whites.

The purpose of this study was to develop a better understanding of the factors that may be contributing to the extraordinarily high rates of uncontrolled HIV in Miami-Dade. Because of the established association between social determinants of health and adverse health outcomes, experts at the University of Miami Department of Public Health Sciences investigated the potential impact of the determinants on the high rates of people who live with HIV who are out of care and/or who have a detectable viral load.

The study suggests that living in neighborhoods with large proportions of poverty, lack of education, and lack of insurance has a detrimental effect on achieving HIV viral load control among people living with HIV, particularly for Black/African Americans. The impact of race then is compounded by the conditions that Black/African Americans with HIV in Miami-Dade endure.

“Reducing poverty, improving education levels and insurance coverage, particularly among Black/African Americans should result in significant reductions in the number of people living with HIV who are out of HIV medical care or who have a detectable viral load,” said study senior author José Szapocznik, Ph.D., professor and chair emeritus at the Miller School of Medicine’s Department of Public Health Sciences.  

Co-authors of the paper included Anamarie Melo, M.P.H., C.P.H., founder of Urban Health Solutions, Imelda K. Moise, Ph.D., M.P.H., assistant professor at the University of Miami Department of Geography and Regional Studies, and Jorge Saavedra, M.D., M.P.H., executive director at UM’s AHF Global Public Health Institute.

Written by Amanda Torres

Published on September 8, 2020