Neighborhood Poverty and Control of HIV, Hypertension, and Diabetes in the Women's Interagency HIV Study

AIDS Behav. 2020 Jul;24(7):2033-2044. doi: 10.1007/s10461-019-02757-5.

Abstract

Neighborhoods with high poverty rates have limited resources to support residents' health. Using census data, we calculated the proportion of each Women's Interagency HIV Study participant's census tract (neighborhood) living below the poverty line. We assessed associations between neighborhood poverty and (1) unsuppressed viral load [VL] in HIV-seropositive women, (2) uncontrolled blood pressure among HIV-seropositive and HIV-seronegative hypertensive women, and (3) uncontrolled diabetes among HIV-seropositive and HIV-seronegative diabetic women using modified Poisson regression models. Neighborhood poverty was associated with unsuppressed VL in HIV-seropositive women (> 40% versus ≤ 20% poverty adjusted prevalence ratio (PR), 1.42; 95% confidence interval (CI) 1.04-1.92). In HIV-seronegative diabetic women, moderate neighborhood poverty was associated with uncontrolled diabetes (20-40% versus ≤ 20% poverty adjusted PR, 1.75; 95% CI 1.02-2.98). Neighborhood poverty was associated with neither uncontrolled diabetes among HIV-seropositive diabetic women, nor uncontrolled hypertension in hypertensive women, regardless of HIV status. Women living in areas with concentrated poverty may need additional resources to control health conditions effectively.

Keywords: Blood pressure; Census tract; Contextual poverty; Health disparity; Viral suppression.

MeSH terms

  • Adult
  • Anti-HIV Agents / economics
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / economics
  • Antiretroviral Therapy, Highly Active / methods*
  • Cohort Studies
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / prevention & control*
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • HIV Infections / virology
  • Humans
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Hypertension / prevention & control*
  • Medication Adherence
  • Middle Aged
  • Poverty Areas
  • Poverty*
  • Prevalence
  • Prospective Studies
  • Residence Characteristics / statistics & numerical data*
  • Social Determinants of Health
  • Socioeconomic Factors
  • Viral Load

Substances

  • Anti-HIV Agents

Grant support