Impact of Socioeconomic Status on the Association between Homosexuality and HIV AIDS

There were approximately 36.7 million people living worldwide with HIV/AIDS at the end of 2016 [Global HIV/AIDS overview 2016]. While there have been a lot of studies conducted about the relation between sexual orientation and HIV, there is not enough research on the impact of socioeconomic status and HIV/AIDS. In this literature study, I aim at shedding a brief light into different stages of an HIV/AIDS in homosexuals and the impact of the socio-economic conditions on their situations.

Scheibe et. al (2016) studied about how social factors influence vulnerability to consequences of HIV infection among men who have sex with men (MSM) in Cape Town, South Africa. Six semi-structured in-depth interviews were conducted with MSM followed by six focus group discussions with a diverse sample of MSM. They found that a wide range of factors like religion (58% HIV patients practiced Christianity while 15% were Muslims), culture and political context have a great impact on the lives of MSM in South Africa and it could contribute to different levels of vulnerability. It was found that all these factors were directly influenced by socioeconomic status. Being Caucasian (15%) were believed to provide a degree of protection against several factors that contributes to vulnerability to HIV. In addition to race, employment status (HIV occurrence: Unemployed 36%, part time 40%, full time 24%) and educational achievements were found to be important part of social positions.

The stigma and discrimination that the low income MSM faced in the school system was thought to negatively affect school performance and thus career opportunity[Scheibe et. al (2016)]. The prevalent stigma is the antiquated misinformation about sexual orientation based on historical social myths. As observed by one of the respondents of the focus group, the trauma of being physiologically different is more stressful in less wealthy areas. It was also found in the study that MSM with lower incomes were more likely to engage themselves in high-risk practices and thus make themselves more vulnerable to the risks of HIV. This marginalization of the economically weak and the stigmatization leads to poor education and increased vulnerability a section of the society.

Rodriguez diaz', Jovel Toledo et. al (2015) examined the socioeconomic factors and sexual health in HIV positive men who have sex with men in Puerto Rico. Socioeconomic factors that were studied were age, education level, employment, religion and partnership status. Sexual health factors studied were sexual satisfaction, condom use and sexual health knowledge (SHK). The participants who were unemployed (45.18% of the total) reported a lower rate of condom use that those who were employed/students. The research findings showed that there is a correlation of sexual health education and its impact on HIV related risks. Interestingly, the study also remains cautious of the implicit assumptions of the possible monotony of the sample set. It would be interesting to correlate the findings of this study with data of other STI/STDs among a similar sample set of volunteers.

Kinsler, Wong et.al (2006) studies the relationship between perceived stigma from a health care provider and access to care among 223 low income HIV infected individuals in Los Angeles county. In the study conducted, 54% of the respondents have had homosexual contact while the rest had heterosexual or injected drug use as HIV risks. In the study, over half of the participants reported had an annual income less than $8000 and approximately half (46%)had no insurance. Perceived stigma from the health care provider was assessed in the form of questions like:

After the diagnosis of HIV, has your health care provider been uncomfortable with you?

Has your healthcare provider treated you as an inferior?

Has your healthcare provider preferred to avoid you?

Have you been refused to be served?

It was found that 26% of the respondents reported at least 1 of the 4 types of perceived stigmas from a health care provider. 58% of respondents reported low access to care on at least 1 out of 6 access to care items at baseline. Based on this and results over a 6 month period, the result observes that the primary care providers have implicit biases which negatively influences the healthcare experience of the patients. However, it is also suggested that the only long term sustaining bias is insurance. This is presumably because of unbiased providers being favored among patients.

Joyce, Goldman et. al assessed the socioeconomic circumstances of older patients with HIV and AIDS. Socioeconomic factors included were insurance coverage, employment and financial resources of older and younger adults. They compared subjects who were HIV positive from HIV cost and services utilization study (HCSUS) with subjects from the health and retirement survey (HRS). The study examined employment among HIV positive patients and found out the difference in the age and race of these people. Similar to the aforementioned studies, it was found that Caucasians are more likely to be working than non-Caucasians. Among the non Caucasian populations, the older patients were more likely to surrender employment compared to their younger counterpart. About 27% stopped working within the first year of their diagnosis. Only 9.4% older minorities with HIV had employer-based insurance, whereas 5.37% of non-whites have such coverage. The study found that HIV positive individuals with low earning potential might be more likely to stop working so that they can qualify for public insurance. In-fact majority of those not working receive health insurance through Medicaid/Medicare. Apart from the economic aspect of this study, it also paints the picture of desperation that a large portion of this population may be feeling about the healthcare and the cost of healthcare.

Elford, Jonathan, et al. as well as Lessard, David, et al. found a positive correlation between the economic and racial profile of the participants of their studies and their vulnerability to HIV. It is clear that statistically it is much more likely that the occurrence of HIV in specific predictable sections of the society. Theoretically, these studies could form the basis of targeted education and preventative measures. However, there still needs to be a more detailed analysis from a heterogeneous and universal set of data to construct predictive models for socio-economically vulnerable audience. These studies would form a sustainable action plan for alleviating HIV.

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