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Published in: Journal of Urban Health 6/2019

01-12-2019

Relationship of Racial Residential Segregation to Newly Diagnosed Cases of HIV among Black Heterosexuals in US Metropolitan Areas, 2008–2015

Authors: Umedjon Ibragimov, Stephanie Beane, Adaora A. Adimora, Samuel R. Friedman, Leslie Williams, Barbara Tempalski, Ron Stall, Gina Wingood, H. Irene Hall, Anna Satcher Johnson, Hannah L. F. Cooper

Published in: Journal of Urban Health | Issue 6/2019

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Abstract

Social science and public health literature has framed residential segregation as a potent structural determinant of the higher HIV burden among black heterosexuals, but empirical evidence has been limited. The purpose of this study is to test, for the first time, the association between racial segregation and newly diagnosed heterosexually acquired HIV cases among black adults and adolescents in 95 large US metropolitan statistical areas (MSAs) in 2008–2015. We operationalized racial segregation (the main exposure) using Massey and Denton’s isolation index for black residents; the outcome was the rate of newly diagnosed HIV cases per 10,000 black adult heterosexuals. We tested the relationship of segregation to this outcome using multilevel multivariate models of longitudinal (2008–2015) MSA-level data, controlling for potential confounders and time. All covariates were lagged by 1 year and centered on baseline values. We preliminarily explored mediation of the focal relationship by inequalities in education, employment, and poverty rates. Segregation was positively associated with the outcome: a one standard deviation decrease in baseline isolation was associated with a 16.2% reduction in the rate of new HIV diagnoses; one standard deviation reduction in isolation over time was associated with 4.6% decrease in the outcome. Exploratory mediation analyses suggest that black/white socioeconomic inequality may mediate the relationship between segregation and HIV. Our study suggests that residential segregation may be a distal determinant of HIV among black heterosexuals. The findings further emphasize the need to address segregation as part of a comprehensive strategy to reduce racial inequities in HIV.
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Metadata
Title
Relationship of Racial Residential Segregation to Newly Diagnosed Cases of HIV among Black Heterosexuals in US Metropolitan Areas, 2008–2015
Authors
Umedjon Ibragimov
Stephanie Beane
Adaora A. Adimora
Samuel R. Friedman
Leslie Williams
Barbara Tempalski
Ron Stall
Gina Wingood
H. Irene Hall
Anna Satcher Johnson
Hannah L. F. Cooper
Publication date
01-12-2019
Publisher
Springer US
Published in
Journal of Urban Health / Issue 6/2019
Print ISSN: 1099-3460
Electronic ISSN: 1468-2869
DOI
https://doi.org/10.1007/s11524-018-0303-1

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