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dc.contributor.authorRansome, Yusuf
dc.contributor.authorBatson, Ashley
dc.contributor.authorGalea, Sandro
dc.contributor.authorKawachi, Ichiro
dc.contributor.authorNash, Denis
dc.contributor.authorMayer, Kenneth
dc.date.accessioned2019-08-30T07:44:18Z
dc.date.issued2017
dc.identifier.citationRansome, Yusuf, Ashley Batson, Sandro Galea, Ichiro Kawachi, Denis Nash, and Kenneth H. Mayer. 2017. “The Relationship between Higher Social Trust and Lower Late HIV Diagnosis and Mortality Differs by Race/Ethnicity: Results from a State-Level Analysis.” Journal of the International AIDS Society 20 (1): 21442. https://doi.org/10.7448/ias.20.01/21442.
dc.identifier.issn1758-2652
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:41288138*
dc.description.abstractIntroduction: Black men who have sex with men (MSM) continue to suffer a disproportionate burden of new HIV diagnoses and mortality. To better understand some of the reasons for these profound disparities, we examined whether the association between social trust and late HIV diagnosis and mortality differed by race/ethnicity, and investigated potential indirect effects of any observed differences. Methods: We performed generalized structural equation modelling to assess main and interaction associations between trust among one's neighbours in 2009 (i.e. social trust) and race/ethnicity (Black, White, and Hispanic) predicting late HIV diagnosis (a CD4 count <= 200 cell/mu L within three months of a new HIV diagnosis) rates and all-cause mortality rates of persons ever diagnosed late with HIV, across 47 American states for the years 2009-2013. We examined potential indirect effects of state-level HIV testing between social trust and late HIV diagnosis. Social trust data were from the Gallup Healthways Survey, HIV data from the Centers for Disease Control and Prevention, and HIV testing from the Behavioral Risk Factor Surveillance System. Covariates included state-level structural, healthcare, and socio-demographic factors including income inequality, healthcare access, and population density. We stratified analysis by transmission group (male-to-male, heterosexual, and injection drug use (IDU)). Results: States with higher levels of social trust had lower late HIV diagnosis rates: Adjusted Rate Ratio [aRR] were consistent across risk groups (0.57; 95% CI 0.53-0.62, male-to-male), (aRR 0.58; 95% CI 0.54-0.62, heterosexual) and (aRR 0.64; 95% CI 0.60-0.69, IDU). Those associations differed by race/ethnicity (all p < 0.001). The associations were most protective for Blacks followed by Hispanics, and least protective for Whites. HIV testing mediated between 18 and 32% of the association between social trust and late HIV diagnosis across transmission group but for Blacks relative to Whites only. Social trust was associated with lower all-cause mortality rates and that association varied by race/ethnicity within the male-to-male and IDU transmission groups only. Conclusions: Social trust may promote timely HIV testing, which can facilitate earlier HIV diagnosis, thus it can be a useful determinant to monitor the relationship with HIV care continuum outcomes especially for racial/ethnic minority groups disproportionately infected by HIV.
dc.language.isoen_US
dash.licenseLAA
dc.titleThe relationship between higher social trust and lower late HIV diagnosis and mortality differs by race/ethnicity: results from a state-level analysis
dc.typeJournal Article
dc.description.versionVersion of Record
dc.relation.journalJournal of the International AIDS Society
dash.depositing.authorKawachi, Ichiro::3b17e788dad605ac69e3dd457b6c41ac::600
dc.date.available2019-08-30T07:44:18Z
dash.workflow.comments1Science Serial ID 60578
dc.identifier.doi10.7448/IAS.20.01/21442
dash.source.volume20;1


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