The Open AIDS Journal

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An Examination of Geographic Differences in Social Determinants of Health Among Women with Diagnosed HIV in the United States and Puerto Rico, 2017

Ndidi Nwangwu-Ike1, *, Chan Jin2, Zanetta Gant1, Shacara Johnson1, Alexandra B. Balaji1
1 National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
2 ICF, Atlanta, GA, USA



To examine differences, at the census tract level, in the distribution of human immunodeficiency virus (HIV) diagnoses and social determinants of health (SDH) among women with diagnosed HIV in 2017 in the United States and Puerto Rico.


In the United States, HIV continues to disproportionately affect women, especially minority women and women in the South.


Data reported in the National HIV Surveillance System (NHSS) of the Centers for Disease Control and Prevention were used to determine census tract-level HIV diagnosis rates and percentages among adult women (aged ≥18 years) in 2017. Data from the American Community Survey were combined with NHSS data to examine regional differences in federal poverty status, education level, income level, employment status, and health insurance coverage among adult women with diagnosed HIV infection in the United States and Puerto Rico.


In the United States and Puerto Rico, among 6,054 women who received an HIV diagnosis in 2017, the highest rates of HIV diagnoses generally were among those who lived in census tracts where the median household income was less than $40,000; at least 19% lived below the federal poverty level, at least 18% had less than a high school diploma, and at least 16% were without health insurance.


This study is the first of its kind and gives insight into how subpopulations of women are affected differently by the likelihood of an HIV diagnosis. The findings show that rates of HIV diagnosis were highest among women who lived in census tracts having the lowest income and least health coverage.

Keywords: HIV, Census tract, Healthcare, Poverty, Social determinants of health, Women.

Article Information

Identifiers and Pagination:

Year: 2021
Volume: 15
First Page: 10
Last Page: 20
Publisher Id: TOAIDJ-15-10
DOI: 10.2174/1874613602115010010

Article History:

Received Date: 21/07/2020
Revision Received Date: 23/12/2020
Acceptance Date: 23/12/2020
Electronic publication date: 16/02/2021
Collection year: 2021

© 2021 Nwangwu-Ike et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA; Tel: 404-639-1811; Fax: 404-639-2980; E-mail:

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