Health disparities and planning in Virginia: Poverty, HIV/AIDS, and Sexually Transmitted Diseases (STDs)

Due to a lack of socioeconomic indicators collected through routine HIV/AIDS and STD surveillance, states present only descriptive data on poverty in planning tools used to allocate funding to target populations. Rarely is the association between poverty, incidence rates, and characteristics of target populations quantified for state planning. Methods developed by the Public Health Disparities Geocoding Project were used to analyze diagnosed cases of HIV/AIDS, total early syphilis (TES), gonorrhea (NG) and chlamydia (CT) from 2000-2005. Cases were geocoded to the census tract level and each tract was stratified into discrete poverty categories (0-4.9%, 5-9.9%, 10-19.9%, 20.0-100%). Age-standardized rates, gamma confidence intervals, and incidence rate ratios (IRRs) were calculated for each outcome and poverty level. The characteristics of target populations, identified by the Virginia HIV Community Planning Group, were proportioned in each poverty level and tested for statistical differences (Tukey-type). The age-standardized rates were highest in tracts where 20-100% of the population lives below poverty (CT 400/100,000, NG 362/100,000, HIV/AIDS 53/100,000, TES 10/100,000). The IRRs between the least/most impoverished tracts were CT 4, NG 11, HIV/AIDS 5, and TES 10. For HIV/AIDS case reports, target population proportions were significantly different (p<0.05) between the least/most impoverished tracts (Men who have sex with Men (42% vs. 27%) and Injection Drug Users (7% vs. 12%)). There is quantitative evidence of socioeconomic disparity in the diagnosis of HIV/AIDS and STDs at the census tract level in Virginia. Furthermore, poverty levels are sensitive enough to detect differences in populations of interest to HIV/AIDS planners.