The State of HIV: An Analysis of the End the HIV Epidemic Initiative in the United States




Delgado, Adolph Joseph

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This dissertation examines the variation in the six End HIV Epidemic (EHE) indicators at state, county, and individual levels in the United States, contextualizing them within the ongoing HIV epidemic since 1981. Despite significant strides in reducing new HIV infections, with over 1.2 million people in the US living with HIV, the epidemic disproportionately impacts specific demographics and regions. Paper II analyzes state-level factors, revealing that states with higher populations of males, people of color, high income inequality, and economically disadvantaged individuals (those without diplomas or income) show increased HIV diagnoses and incidences. Paper III extends this analysis to EHE-targeted counties, highlighting counties composed of younger populations, higher representation of males and Hispanics, and significant socio-economic disadvantages such as lack of diplomas, insurance, income, and heightened income inequality have higher levels of HIV diagnoses and incidences. Paper IV, focuses on individual-level factors within Bexar County, a high-risk EHE-targeted area, identifying respondents who have been diagnosed with depression having a lower likelihood of knowing their HIV status, suggesting mental health barriers to testing. Interestingly, respondents who are sexually active, have casual sex partners, and have sex when they are using drugs, have a higher likelihood of knowing their HIV status. These findings emphasize the need for multifaceted public health strategies addressing the varied challenges of HIV at each level. The dissertation aligns with the EHE initiative's goal to significantly reduce new infections by 2030 and advocates for comprehensive policy initiatives and future research to end the HIV epidemic in the US.



End HIV Epidemic, Income inequality, Sexually active, Depression, Sex partners