Study of New Orleans Neighborhoods, Time to Viral Suppression, Shows Long Shadow of Redlining

Experts view the redlining of neighborhoods as an important part of the structural racism that leads to health and healthcare inequities. Results reported last week in JAMA Internal Medicine of a study of people with HIV in New Orleans add to the evidence of the long-term effects of redlining.

Corresponding author of John R. Bassler, M.S., a statistician at the University of Alabama at Birmingham, and his colleagues found the median time to viral suppression was 29 days longer among people living in neighborhoods that had been redlined compared with those in nonredlined neighborhoods (193 days vs. 164 days). Other ways of analyzing the data also pointed to the lingering effects of redlining. For example, 7 (53.8%) of the 13 neighborhoods with the longest time to viral suppression (270 days or greater) were redlined neighborhoods. And a greater proportion of those living in nonredlined neighborhoods achieved viral suppression within three months of diagnosis than those in redlined neighborhoods (30.3% vs. 26.1%). Put yet another way, 600 (86%) of the 697 individuals with HIV in redlined neighborhoods achieved viral suppression compared with 388 89%) of 435 of those in nonredlined neighborhoods.

The study included 1,132 people living in New Orleans who were diagnosed with HIV between Jan. 1, 2011,and Dec.31,2019. Redlining refers to the color-coded system that the federal Home Owners’ Loan Corporation used to classified neighborhoods after the Great Depression. Neighborhoods where members of racial and minority groups lived, as well as immigrants, and Jewish people, were typically labeled as being the riskiest and thus redlined.

Time to viral suppression is the time between HIV diagnosis and low viral load of HIV in the blood. In this study, the researchers used less than 200 copies of HIV per milliliter of blood as the cutoff indicating viral suppression. Other studies and programs use different levels. Regardless of the level used, time to viral suppression is viewed as a good proxy for the adequacy in HIV care: The longer the time to viral suppression, the worse the care.

Bassler and his colleagues also studied gentrification, which was defined as increases in educational attainment and in housing value. Among those living in gentrifying neighborhoods, those living in redlined neighborhoods had longer time to viral suppression than those in nonredlined neighborhoods.

When researchers made adjustments for year of diagnosis, raceand mode of transmission, the redlined vs. nonredlined differences were reduced but still present and still met the standards for statistical significance.

Bassler and his colleagues acknowledged some limitations, including missing address information and applying measures across census tracts even though there can be wide variability withing a census tract. In addition, there are many factors affecting to time to viral suppression.

Still, they concluded, their findings show the “enduring effects of systemic racism on present-day health” and that regardless of gentrification, people in redlined neighborhoods may experience a longer time to viral suppression.