Attention to Social Determinants in State and Local HIV Epidemiological Profiles

Background:  Through RFA-PS12-1201, the CDC funds the HIV prevention efforts of 59 state and local health departments (LHD).  The LHDs must complete HIV epidemiological profiles to describe their epidemics and inform local allocation.  The CDC issues guidance on profile completion, encouraging attention to social determinants of risk.  Yet, the guidance does not offer specific suggestions for data capture on some groups shown by research to have elevated rates of and risk for HIV: 1) homeless individuals, 2) transgender individuals, 3) individuals with a serious mental illness, and 4) survivors of trauma.  Without local data, these populations will not receive targeted HIV prevention services with these funds.  This study explores if and how LHDs consider HIV rates among these four particularly vulnerable populations.

Methods:  The HIV epidemiological profiles of 58 LHDs are posted online.  Those 58 profiles were analyzed to determine the level of attention given to the four populations, using five ordinal categories: 1) primary epidemiological data, 2) supplemental data, 3) local Ryan White data, 4) discussed, and 5) ignored. 

Results:  Few profiles included data on the four populations.  For primary epidemiological data, only 5 profiles (8.6%) attended to transgender, 3 profiles (5.2%) attended to homeless, 1 profile (1.7%) attended to SMI, and 0 profiles attended to trauma. Percentages increased slightly when we considered supplemental data sources: transgender (n =9, 15.5%), homeless (n =7, 12.1%), SMI (n =4, 6.9%), and trauma (n =2, 3.4%). 

Conclusions:  Although the CDC encourages attention to social determinants, some relevant factors are largely ignored in LHD data and CDC guidance, precluding targeted prevention.  This also prevents exploration of how these factors intersect with other risk factors. These findings argue for increased attention to social determinants in local HIV epidemiological data and CDC guidance as a means of enhancing the overall quality of HIV prevention.