Neighborhood-level determinants of delayed HIV diagnosis and survival among HIV-positive Latinos, Florida 2000-2011

The purpose of this study was to estimate disparities in late human immunodeficiency virus (HIV) diagnosis and all-cause mortality among varying populations of HIV-positive Latinos, and to identify neighborhood-level predictors. Florida HIV surveillance data for years 2000–2011 were merged with 2007–2011 American Community Survey (ACS) data. Multilevel logistic regressions were used to estimate adjusted odds ratios (aOR) for late HIV diagnosis (acquired immunodeficiency syndrome within 3 months of HIV diagnosis). Multilevel weighted Cox regressions were used to estimate adjusted hazard ratios (aHR) for mortality. Of 5522 Latinos diagnosed 2007–2011, males were at increased odds of late diagnosis compared with females (aOR 1.37, 95% confidence interval [CI] 1.13-1.67). Associated factors included residing in the lowest quartile of neighborhood education for females, and in the 3 highest quartiles of unemployment for males. Foreign-born compared with United States (US)-born Latinos were also at risk (aOR 1.24, 95% CI 1.08-1.42). Among foreign-born, residing in areas with \u3c25% Latinos (aHR 1.67, 95% CI 1.01-2.70). Targeted and improved neighborhood-level HIV diagnosis, care and treatment strategies are warranted for Latinos. Males and foreign-born Latinos are at particular risk of delayed HIV diagnosis. Latinos with IDU history and those born in Puerto Rico are at increased mortality risk after HIV diagnosis. Results suggest that these at-risk groups interact uniquely with their environments and have distinct contributing factors to HIV- related outcomes