142nd APHA Annual Meeting and Exposition

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Association of neighborhood-level socioeconomic status (SES) with time from HIV diagnosis to viral suppression among newly diagnosed New Yorkers, 20062010

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 4:30 PM - 4:45 PM

Ellen W. Wiewel, MHS , School of Public Health, The Graduate Center, CUNY, New York, NY
Lucia V. Torian, PhD , New York City Department of Health and Mental Hygiene, Long Island City, NY
Andrew R. Maroko, PhD , Department of Health Sciences, Lehman College, City University of New York, Bronx, NY
Heidi E. Jones, PhD, MPH , Epidemiology & Biostatistics Program, CUNY School of Public Health, Hunter College, New York, NY
Luisa N. Borrell, DDS, PhD , Lehman College, CUNY, Bronx, NY

HIV viral suppression decreases the probability of onward transmission and is a goal of the National HIV/AIDS Strategy.  Population-based analyses of viral suppression have not examined the influence of neighborhood-level SES.


Demographics (age, sex, race, area of birth), transmission risk, diagnosis date, viral loads, CD4 counts, and address of residence at diagnosis from the New York City HIV surveillance registry were linked to census tract-level SES measures for poverty (percent of residents with incomes under federal poverty threshold), unemployment (among residents 16+), and education (percent of residents 25+ graduated from high school) from 2011 American Community Survey 5-year estimates.  Among persons newly diagnosed with HIV in 2006–2010, 13+ years old at diagnosis, who had tract-level SES variables (84% of total cases 13+), we calculated days from HIV diagnosis to first suppression (≤400 copies of RNA/mL plasma), with follow-up through 12/31/2012.  Multilevel Cox proportional hazards regression estimated the association of tract-level SES measures with time to suppression, controlling for individual demographics, risk, diagnosis year, and treatment eligibility.


Out of 14,794 New Yorkers newly diagnosed with HIV in 2006–2010, 73.4% achieved viral suppression by 12/31/2012 (median days to suppression: 228).  Neighborhood poverty, unemployment and education levels were not associated with time to suppression even in adjusted models: HR(95%CI)=1.02(0.95-1.09; ≥30% vs. <10% in poverty), 1.00(0.92-1.08; <60% vs. ≥90% graduated high school) and 1.01(0.93-1.09; ≥15% vs. <5% unemployed), respectively.


Among New Yorkers newly diagnosed with HIV, neighborhood-level SES does not influence the time from diagnosis to viral suppression.

Learning Areas:

Social and behavioral sciences

Learning Objectives:
Describe the association of neighborhood-level socioeconomic characteristics with HIV-related viral suppression

Keyword(s): HIV/AIDS, Poverty

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a master's degree in public health and have for ten years analyzed HIV surveillance data for NYC as an epidemiologist with the NYC health department.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.