Incidence of HIV Infection and Census Tract Poverty Level in Massachusetts – An Update to Results from Early in the Epidemic (CSTE Health Disparities Pilot Project)

BACKGROUND: The Massachusetts Department of Public Health (MDPH) has examined health disparities in the incidence of HIV infection as part of the CSTE Pilot Project to Analyze Public Health Data for Health Disparities by Socioeconomic Status Using Census Tract Poverty Level. While we routinely examine trends in racial/ethnic disparities for HIV/AIDS, we have not recently analyzed our data with respect to socioeconomic status (SES). In 2000, we published results of an analysis which identified increased AIDS rates among those residing in economically deprived neighborhoods (Zierler, et al. 2000). This project will update the analysis conducted early in the epidemic.  

METHODS: Using 2000 and 2010 US census tract data and population counts, and MDPH HIV/AIDS surveillance data, we evaluated annual and cumulative incidence of HIV infection in Massachusetts. Geocoding was performed using ArcGIS. The data were stratified by age, sex, race/ethnicity, disease stage, and census tract poverty level to study trends in SES over time for those reported with HIV infection in our state.  

RESULTS: There were 9,480 cases of HIV infection reported from 2000 through 2010. The age distribution of cases was: 1% under 15, 9% ages 15 to 24, 62% ages 25 to 44, 26% ages 45 to 64, and 1% over 65 years old. The racial distribution: <1% American Indian/Alaskan Native, 2% Asian (non-Hispanic), 33% Black (non-Hispanic), 25% Hispanic, <1% Other, and 39% White (non-Hispanic). Thirteen percent of cases were homeless, incarcerated, or had missing address information (1,274/9,480). Of the remaining 8,206 domiciled residents, 83% were successfully geocoded. Among those with incident HIV infection from 2000 through 2005, 38% resided in census tracts where ≥20% of persons were below the poverty line (1,634/4,260); 40% of incident cases from 2006 through 2010 resided in census tracts where ≥20% were below the poverty line (1,104/2,726). Among those reported to have AIDS from 2000 through 2005, 40% resided in census tracts where ≥20% of persons were below the poverty line (1,085/2,744); 39% of incident AIDS cases from 2006 through 2010 resided in census tracts where ≥20% were below the poverty line (454/1,158). [These results are preliminary; additional results are pending, including rates of infection per census tract.]  

CONCLUSIONS: Our study indicates the continuing impact of HIV/AIDS on lower socioeconomic communities. In the earlier study, 36% of incident AIDS cases from 1988 through 1994 resided in census block-groups where ≥20% were below the poverty line (2,909/8,045). [Further discussion/conclusions are pending.]