Date
12-4-2025
Department
School of Health Sciences
Degree
Doctor of Philosophy in Health Sciences (PhD)
Chair
Beth Sexton
Keywords
HIV, stigma, housing instability, social determinants of health, AIDS mortality
Disciplines
Medicine and Health Sciences
Recommended Citation
Martin, Triscia G., "Examining Social Determinants of Health and the Impact on HIV Outcomes in Black People in the United States" (2025). Doctoral Dissertations and Projects. 7688.
https://digitalcommons.liberty.edu/doctoral/7688
Abstract
Black people are disproportionately affected by HIV as evidenced by poor clinical outcomes and mortality. Clinical outcomes may be potentiated by patient factors, compounded by social determinants of health. This cross-sectional study sought to examine the impact of social determinants of health on AIDS mortality in the United States. Deidentified HIV data from the CDC NCHHSTP Atlas Plus repository and CDC WONDER population data were utilized to examine the association of race, sex, transmission category and geography on AIDS mortality in 43 states during 2018 to 2022. AIDS mortality was further examined through the lens of HIV stigma and housing instability. R Studio and IBM SPSS Version 30.0 were used to analyze 66,635 deaths. Black people totaled 28,781 accounting for 43.2 percent of deaths. Mixed Effects Negative Binomial Regression modelling revealed that after controlling for sex, transmission category, year, and geography, AIDS-related deaths were 6.59-fold higher among Black people and 6.58-fold higher in Multiracial persons compared to White people (p < .001). Males had a 3.6-fold increased risk of AIDS mortality compared to females (p < .001). MSM was associated with the greatest risk for AIDS mortality (IRR 4.20; p < .001). Welch’s ANOVA demonstrated that geographic location and AIDS deaths were strongly associated (F = 79.22; p < .001). District of Columbia had the highest AIDS mortality rate (IRR = 4.3; Black people = 48.3 per 100,000 persons). Spearman’s correlation demonstrated an inverse association between HIV stigma, housing instability and AIDS mortality (p < .001). Community, state level measures and legislative reform may be needed to address some of the sociopolitical barriers that impede health care access and mitigate poor outcomes. Future studies are needed to examine the causal relationships between the increased rate of AIDS-related mortality and Black and Multiracial individuals.
