Are Neighborhood Conditions Associated With HIV Management?
Are Neighborhood Conditions Associated With HIV Management?
A total of 762 individuals completed the assessment and had addresses in the St Louis metropolitan area. The majority of the sample were male (n = 512; 67.2%) and African American (n = 566; 74.6%). Nearly 53% of the sample were unemployed or receiving disability benefits. A large proportion endorsed symptoms of MDD/ODDs (n = 278; 36.5%). Approximately one-quarter of the sample were not currently in receipt of ART and 66% (n = 501) of the sample had suppressed HIV viral loads, while 81% (n = 614) had CD4 cell counts > 200 cells/μL. Individuals had been living with HIV for a median of 8.6 years [interquartile range (IQR) 3.0, 13.0 years]. This sample was similar to the larger clinic population. Additional characteristics of the sample are included in Table 1. A total of 273 census tracts were used in the analysis (Table ).
In an unadjusted model, the following parameters were associated with neighbourhoods that had higher poverty rates: male sex, African American race, lower education, current smoking, and the presence of clinical AIDS (see Table 2 for greater detail). Neighbourhoods with higher unemployment rates were associated with male sex, older age, African American race, smoking, lower income, clinical AIDS, and lower rates of ART prescription. Racially segregated neighbourhoods were associated with male sex, lower education, unemployment, and the presence of depressive symptoms (Table 2).
In the adjusted models, individuals residing in neighbourhoods with higher poverty rates were more likely to have CD4 cell counts < 200 cells/μL [odds ratio (OR) 1.56; 95% confidence interval (CI) 1.05–2.44] and more likely to be current smokers (OR 1.45; 95% CI 1.04–2.02). In neighbourhoods with higher rates of unemployment, individuals were less likely to have a current ART prescription (OR 1.47; 95% CI 1.05–2.04). In neighbourhoods that were more racially segregated, individuals more often reported depression symptoms (OR 1.51; 95% CI 1.04–2.22) (Table 3). These additional factors failed to demonstrate an independent association after controlling for other factors: age, gender, race, education, income, depression (except depression outcome), number of sex partners and events of unprotected sex.
Results
A total of 762 individuals completed the assessment and had addresses in the St Louis metropolitan area. The majority of the sample were male (n = 512; 67.2%) and African American (n = 566; 74.6%). Nearly 53% of the sample were unemployed or receiving disability benefits. A large proportion endorsed symptoms of MDD/ODDs (n = 278; 36.5%). Approximately one-quarter of the sample were not currently in receipt of ART and 66% (n = 501) of the sample had suppressed HIV viral loads, while 81% (n = 614) had CD4 cell counts > 200 cells/μL. Individuals had been living with HIV for a median of 8.6 years [interquartile range (IQR) 3.0, 13.0 years]. This sample was similar to the larger clinic population. Additional characteristics of the sample are included in Table 1. A total of 273 census tracts were used in the analysis (Table ).
In an unadjusted model, the following parameters were associated with neighbourhoods that had higher poverty rates: male sex, African American race, lower education, current smoking, and the presence of clinical AIDS (see Table 2 for greater detail). Neighbourhoods with higher unemployment rates were associated with male sex, older age, African American race, smoking, lower income, clinical AIDS, and lower rates of ART prescription. Racially segregated neighbourhoods were associated with male sex, lower education, unemployment, and the presence of depressive symptoms (Table 2).
In the adjusted models, individuals residing in neighbourhoods with higher poverty rates were more likely to have CD4 cell counts < 200 cells/μL [odds ratio (OR) 1.56; 95% confidence interval (CI) 1.05–2.44] and more likely to be current smokers (OR 1.45; 95% CI 1.04–2.02). In neighbourhoods with higher rates of unemployment, individuals were less likely to have a current ART prescription (OR 1.47; 95% CI 1.05–2.04). In neighbourhoods that were more racially segregated, individuals more often reported depression symptoms (OR 1.51; 95% CI 1.04–2.22) (Table 3). These additional factors failed to demonstrate an independent association after controlling for other factors: age, gender, race, education, income, depression (except depression outcome), number of sex partners and events of unprotected sex.
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