HIV Health and Care Outcomes Affected by Social and Economic Disadvantages

Researchers assessed social determinants of health among people living with HIV and the impact of social and economic disadvantages on key HIV care outcomes.

Care outcomes of HIV were found to be influenced in a dose-dependent relationship by economic and social disadvantages, according to findings of a cross-sectional study published in Open Forum Infectious Diseases.

Researchers with the Public Health Division in Portland, Oregon, analyzed data from the Centers for Disease Control and Prevention Medical Monitoring Project. Survey responses collected between 2015 and 2019 were assessed by the newly developed Oregon Social Determinants of HIV Health Index (OSHI), which used 5 domains (education, economic stability, health, neighborhood and built environment, and social and community) to score individuals between 0 (no disadvantage) and 10 (most disadvantage).

A total of 15,964 individuals living with HIV participated in this study: 41.1% were Black, 29.5% were White, and 23.3% were Hispanic; 50.3% were 50 years and older; and 49.8% were men who have sex with men.

Results of OSHI scores were 0 (17%), 1 (23%), 2 (20%), 3 (16%), or ≥4 (25%), and the average was 2.30 (95% CI, 2.25-2.35). The most common indicators of disadvantage were poverty (43%), visits to the emergency department during the previous year (39%), intimate partner violence (33%), and need for transportation assistance (32%).

Missed medical appointments occurred among 24%, and all OSHI components were associated. Individuals who missed an appointment had an average score of 3.13 (95% CI, 3.05-3.21) compared with 2.04 (95% CI, 1.98-2.09) for those who did not. In the fully adjusted model, those with OSHI scores of 1, 2, 3, and ≥4 were at 1.6-, 2.1-, 2.6-, and 3.6-times greater risk, respectively, for missing a medical appointment compared with those who had a score of 0.

Excellent adherence to HIV medications during the previous 30 days was reported by 60%; all OSHI components, except for level of education, were associated. Individuals with excellent adherence to medications had a mean score of 2.01 (95% CI, 1.96-2.06) compared with 2.57 (95% CI, 2.50-2.64) for those who did not have adequate adherence. Scores of 1, 2, 3, and ≥4 were 11%, 17%, 20%, and 31% less likely to report excellent medication adherence compared with a score of 0.

Successful viral suppression during the previous 12 months was achieved by 63%; all OSHI components, except health literacy and domestic violence, were associated. Participants who experienced viral suppression had an average OSHI score of 2.12 (95% CI, 2.06-2.17) compared with 2.64 (95% CI, 2.56-2.73) among those without suppression. Individuals with OSHI scores of 1, 2, 3, and ≥4 were 2%, 4%, 10%, and 20% less likely to achieve durable viral repression compared with individuals who had a score of 0.

This study may have been limited by formulating risk factors on the basis of survey questions and may not have included all relevant risk factors.

These data indicated that social and economic disadvantages affected HIV care in a dose-dependent manner. The OSHI score may be effective at rapidly screening individuals in need of social assistance.


Menza TW, Hixson LK, Lipira L, Drach L. Social determinants of health and care outcomes among people living with HIV in the United States. Open Forum Infect Dis. 2021;ofab330. doi:10.1093/ofid/ofab330