Grant: CIHR Fellowship

HIV remains a global public health threat, with 37 million people living with HIV (PLWH). Advancements in HIV therapy have transformed the clinical landscape increasing life expectancies and reducing new HIV infections. But benefits rest on the lifetime commitment of PLWH to adhere to treatments. Over the last 20 years, the proportion of patients virally suppressed- and therefore those with controlled infections- has risen from 25% to over 80% in the United States (US). Although encouraging, progress is uneven and falls short of global targets. Race continues to play a differentiating role in the inequality of HIV infections. African Americans make up more than half of new cases while only representing 14% of the US population. Moreover, even in cities with universal health care coverage such as San Francisco, where overall ~85% of PLWH are virally suppressed, that number plummets to 30% among those marginally housed and homeless. Worldwide, people who fare poorly in HIV care have little or no access to care, face stigma and encounter socio-structural barriers. Socioeconomic status and race have been shown to predict health outcomes. But research on this topic has not optimally captured the multi-dimensional ways in which disparities interact and how this leads to adverse health outcomes for PLWH. For example, low income is often the consequence of mental illness, substance abuse, limited education. Even though each of these factors has been shown to be associated with poor health outcomes, the extent to which these factors intersect to create underlying expressions of socioeconomic deprivation remains to be explored. Identifying and understanding the consequences of disparities is the first step in addressing inequalities through targeted interventions and health policies. Results from this research will characterize and evaluate the role of socioeconomic drivers of HIV care engagement, which will ultimately play a critical role in ending the HIV epidemic.