{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:30:39Z","timestamp":1791639039469,"version":"4.3.4"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec id=\"ab-ioi240063-4\"><jats:title>Importance<\/jats:title><jats:p>Structural racism in the US is evidenced in the discriminatory practice of historical racial redlining when neighborhoods were valued, in part, based on the community\u2019s racial and ethnic compositions. However, the influence of these systemic practices in the context of the HIV epidemic is not well understood.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240063-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the effect of redlining on time to viral suppression among people newly diagnosed with HIV.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240063-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>Observational study that included individuals diagnosed with HIV from January 1, 2011, to December 31, 2019, in New Orleans, Louisiana. At the time of their HIV diagnosis, these individuals lived in neighborhoods historically mapped by the Home Owners\u2019 Loan Corporation (HOLC). The HOLC lending risk maps classified neighborhoods into 1 of 4 color-coded grades: A (best), B (still desirable), C (definitely declining), and D (hazardous).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240063-7\"><jats:title>Main Outcome and Measures<\/jats:title><jats:p>The primary outcome of interest was time to viral suppression (estimated as the time from the diagnosis date to the date of the first recorded viral load that was &amp;amp;lt;200 copies\/mL). Individual-level demographic factors were used to evaluate time to viral suppression along with a neighborhood measure of gentrification (based on US census tract\u2013level characteristics for educational attainment, housing development and value, and household income) and a Cox gamma frailty model with census tract used as the frailty term.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240063-8\"><jats:title>Results<\/jats:title><jats:p>Of 1132 individuals newly diagnosed with HIV, 871 (76.9%) were men and 620 (54.8%) were 25 to 44 years of age. Of the 697 individuals living in historically redlined neighborhoods (HOLC grade D), 100 (14.6%) were living in neighborhoods that were gentrifying. The median time to viral suppression was 193 days (95% CI, 167-223 days) for persons with HIV living in redlined neighborhoods compared with 164 days (95% CI, 143-185 days) for the 435 persons with HIV living in HOLC grade A, B, or C (nonredlined) neighborhoods. Among persons with HIV living in gentrifying neighborhoods, those living in redlined neighborhoods had a longer time to viral suppression compared with persons living in nonredlined neighborhoods (hazard ratio, 0.54 [95% CI, 0.36-0.82]).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240063-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>These findings suggest the enduring effects of systemic racism on present-day health outcomes among persons with HIV. Regardless of their neighborhood\u2019s contemporary level of gentrification, individuals diagnosed with HIV while living in historically redlined neighborhoods may experience a significantly longer time to viral suppression.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2024.5003","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T15:32:33Z","timestamp":1727710353000},"page":"1329","source":"Crossref","is-referenced-by-count":10,"title":["Redlining and Time to Viral Suppression Among Persons With HIV"],"prefix":"10.1001","volume":"184","author":[{"given":"John R.","family":"Bassler","sequence":"first","affiliation":[{"name":"Department of Biostatistics, University of Alabama, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Ostrenga","sequence":"additional","affiliation":[{"name":"Louisiana Department of Health, New Orleans"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily B.","family":"Levitan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma S.","family":"Kay","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Alabama, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin M.","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest University, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Mugavero","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alabama, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariann F.","family":"Nassel","sequence":"additional","affiliation":[{"name":"Lister Hill Center for Health Policy, University of Alabama, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariel","family":"Parman","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alabama, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miya","family":"Tate","sequence":"additional","affiliation":[{"name":"School of Social Work, Tulane University, New Orleans, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aadia","family":"Rana","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alabama, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. 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