BACKGROUND: Poverty is linked to health of the individual, and some chronic conditions such as HIV disease might contribute to impoverishment. Pennsylvania’s HIV surveillance data include census tract of residence of diagnosis for people diagnosed with HIV in Pennsylvania outside of Philadelphia since 2011 and also include census tract for the most recently reported address from subsequent lab reports for these same individuals. Separate preliminary analysis indicates that more than 50% of people living with HIV have moved to a different zip code since their initial diagnosis. The objective of this analysis is to evaluate the potential impact of HIV disease and pattern of choice for place of residence after HIV disease diagnosis in Pennsylvania.
METHODS: Data for 1,858 individuals who were diagnosed with HIV disease from 2011 through 2014 and presumed to be alive in 2015 was analyzed. The proportion of people living below poverty for each census tract was obtained from the American Community Survey Data for 2010. The poverty level of the census tract at residence of diagnosis was compared to the poverty level of the most recently reported residence to determine if the individual had moved to a census tract with a higher, lower or was still living in a census tract with a similar level of poverty. The distribution of census tract poverty level at time of diagnosis and most currently reported address was compared as well as the mean and median poverty level by length of time since diagnosis. The proportion of individuals moving to census tracts with higher levels of poverty was also analyzed.
RESULTS: 768 (41%) of the 1,858 individuals examined were currently living in a census tract with a higher level of poverty than the census tract where they were living at time of diagnosis. The mean poverty levels at diagnosis and most recent address were 14% and 20% respectively. More than 70% of people diagnosed with HIV in 2011 or 2012 had moved to a census tract with a higher level of poverty while 10% of those diagnosed in 2013 and 2014 had moved to a census tract with a higher level of poverty.
CONCLUSIONS: The economics of HIV disease on individuals may have a strong influence on choice of housing location, resulting in concentration of people living with HIV in areas with high levels of poverty. The effect appears to become more pronounced the longer a person lives with HIV disease.