Who Is Not Linking to HIV Care in Tennessee - the Benefits of an Intersectional Approach

J Racial Ethn Health Disparities. 2022 Jun;9(3):849-855. doi: 10.1007/s40615-021-01023-6. Epub 2021 Apr 19.


Introduction: Guided by an intersectional approach, we assessed the association between social categories (individual and combined) on time to linkage to HIV care in Tennessee.

Methods: Tennessee residents diagnosed with HIV from 2012-2016 were included in the analysis (n=3750). Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used Cox proportional hazards models to assess the association of time to linkage with individual-level variables. We modeled interactions between race, age, gender, and HIV acquisition risk factor (RF), to understand how these variables jointly influence linkage to care.

Results: Age, race, and gender/RF weAima A. Ahonkhaire strong individual (p < 0.001 for each) and joint predictors of time to linkage to HIV care (p < 0.001 for interaction). Older individuals were more likely to link to care (aHR comparing 40 vs. 30 years, 1.20, 95%CI 1.11-1.29). Blacks were less likely to link to care than Whites (aHR= 0.73, 95% CI: 0.67-0.79). Men who have sex with men (MSM) (aHR = 1.18, 95%CI: 1.03-1.34) and heterosexually active females (females) (aHR = 1.32, 95%CI: 1.14-1.53) were more likely to link to care than heterosexually active males. The three-way interaction between age, race, and gender/RF showed that Black males overall and young, heterosexually active Black males in particular were least likely to establish care.

Conclusions: Racial disparities persist in establishing HIV care in Tennessee, but data highlighting the combined influence of age, race, gender, and sexual orientation suggest that heterosexually active Black males should be an important focus of targeted interventions for linkage to HIV care.

Keywords: HIV care continuum; Intersectionality; Linkage to care; Structural drivers.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Female
  • HIV Infections* / diagnosis
  • HIV Infections* / therapy
  • Homosexuality, Male
  • Humans
  • Male
  • Sexual Behavior
  • Sexual and Gender Minorities*
  • Tennessee