{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:10:45Z","timestamp":1789755045087,"version":"4.0.1"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["F31MD018550"],"award-info":[{"award-number":["F31MD018550"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Assess associations between COVID-19 vaccine availability and differences in COVID-19 mortality risk across subgroups among 122,527 people with HIV (PWH) in Florida.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Analyzed HIV surveillance data, Social Vulnerability Index (SVI), and Rural-Urban Commuting Area Codes using a competing risks model to compare COVID-19 mortality among PWH before (3\/1\/2020\u20134\/30\/2021) and during (5\/1\/2021\u201312\/31\/2021) vaccine availability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall COVID-19 mortality rates increased from before to during the vaccine availability period (22.3 vs. 27.5 per 100,000 person-months), driven in part by the Delta variant surge in mid-to-late 2021. Compared to Non-Hispanic White (NHW) PWH, adjusted COVID-19 mortality hazards remained elevated for Non-Hispanic Black (NHB) PWH both before (HR 2.06, 95% CI 1.45\u20132.91) and during (HR 1.60, 95% CI 1.13\u20132.27) vaccine availability. For Hispanic PWH, the relative hazard compared to NHW was elevated before (HR 2.24, 95% CI 1.55\u20133.23) and attenuated during vaccine availability (HR 1.03, 95% CI 0.68\u20131.57). In the final model, living in ZIP Code-level areas of high social vulnerability (overall SVI high vs. low) was associated with elevated hazard during vaccine availability (HR 1.75, 95% CI 1.04\u20132.97).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall COVID-19 mortality rates were higher during the vaccine availability period (27.5 vs. 22.3 per 100,000 person-months); however, subgroup patterns varied substantially. Inequities persisted in key subgroups and were most pronounced among PWH living in more socially vulnerable areas. These observational comparisons do not estimate the causal effect of vaccination uptake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Public health implications<\/jats:title>\n                    <jats:p>Tailored vaccination strategies and structural interventions remain essential to advancing equity in pandemic response among PWH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358543","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:41:52Z","timestamp":1789753312000},"page":"e0358543","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["COVID-19 mortality risk among people with HIV in Florida before and after the introduction of COVID-19 vaccines: A population-based study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2110-3530","authenticated-orcid":true,"given":"Tendai N.R.","family":"Gwanzura","sequence":"first","affiliation":[{"name":"Florida International University","place":["Miami, Florida, United States of America"],"department":["Robert Stempel School of Public Health and Social Work, Department of Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6585-1194","authenticated-orcid":true,"given":"Mary Jo","family":"Trepka","sequence":"additional","affiliation":[{"name":"Florida International University","place":["Miami, Florida, United States of America"],"department":["Robert Stempel School of Public Health and Social Work, Department of Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan","family":"Li","sequence":"additional","affiliation":[{"name":"Florida International University","place":["Miami, Florida, United States of America"],"department":["Robert Stempel School of Public Health and Social Work, Department of Biostatistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3393-4021","authenticated-orcid":true,"given":"Levente","family":"Juhasz","sequence":"additional","affiliation":[{"name":"University of Florida","place":["Davie, Florida, United States of America"],"department":["Ft. Lauderdale Research & Education Center, School of Forest, Fisheries and Geomatics Sciences, Geospatial Analytics, Technology, and Open Research (GATOR) Lab"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7937-036X","authenticated-orcid":true,"given":"Giselle A.","family":"Barreto","sequence":"additional","affiliation":[{"name":"Florida International University","place":["Miami, Florida, United States of America"],"department":["Robert Stempel School of Public Health and Social Work, Department of Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelbie","family":"Burchfield","sequence":"additional","affiliation":[{"name":"Florida International University","place":["Miami, Florida, United States of America"],"department":["Robert Stempel School of Public Health and Social Work, Department of Biostatistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana M.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Florida International University","place":["Miami, Florida, United States of America"],"department":["Robert Stempel School of Public Health and Social Work, Department of Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"pone.0358543.ref001","unstructured":"Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Provisional Mortality on CDC WONDER Online Database. Data are from the final Multiple Cause of Death Files, 2018-2024, and from provisional data for years 2025 and later, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. [cited 2026 Jul 8]. Available from: http:\/\/wonder.cdc.gov\/mcd-icd10-provisional.html"},{"key":"pone.0358543.ref002","doi-asserted-by":"crossref","first-page":"519","DOI":"10.15585\/mmwr.mm7014e1","article-title":"Provisional mortality data \u2014 United States, 2020","volume":"70","author":"FB Ahmad","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0358543.ref003","doi-asserted-by":"crossref","first-page":"597","DOI":"10.15585\/mmwr.mm7117e1","article-title":"Provisional mortality data \u2014 United States, 2021","volume":"71","author":"FB Ahmad","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"26","key":"pone.0358543.ref004","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000026573","article-title":"HIV infection and risk of COVID-19 mortality: a meta-analysis","volume":"100","author":"Y Dong","year":"2021","journal-title":"Medicine (Baltimore)"},{"issue":"6","key":"pone.0358543.ref005","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.jiph.2022.05.006","article-title":"Risk of mortality in HIV-infected COVID-19 patients: a systematic review and meta-analysis","volume":"15","author":"T Dzinamarira","year":"2022","journal-title":"J Infect Public Health"},{"issue":"7","key":"pone.0358543.ref006","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1007\/s10461-022-03578-9","article-title":"Risk factors for COVID-19 mortality among people living with HIV: a scoping review","volume":"26","author":"K Varshney","year":"2022","journal-title":"AIDS Behav"},{"issue":"2","key":"pone.0358543.ref007","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/jrh.12557","article-title":"The association of social determinants of health with COVID-19 mortality in rural and urban counties","volume":"37","author":"R Paul","year":"2021","journal-title":"J Rural Health"},{"key":"pone.0358543.ref008","article-title":"Socioeconomic determinants of COVID-19 incidence and mortality in Florida","volume":"14","author":"S Backer","year":"2022","journal-title":"Cureus"},{"key":"pone.0358543.ref009","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-069317","article-title":"Public health impact of covid-19 vaccines in the US: observational study","volume":"377","author":"AB Suthar","year":"2022","journal-title":"BMJ"},{"key":"pone.0358543.ref010","doi-asserted-by":"crossref","first-page":"2257","DOI":"10.1093\/cid\/ciab079","article-title":"The impact of vaccination on coronavirus disease 2019 (COVID-19) outbreaks in the United States","volume":"73","author":"SM Moghadas","year":"2021","journal-title":"Clin Infect Dis"},{"key":"pone.0358543.ref011","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.amepre.2022.08.005","article-title":"COVID-19 vaccination and racial\/ethnic inequities in mortality at midlife in Minnesota","volume":"64","author":"E Wrigley-Field","year":"2023","journal-title":"Am J Prev Med"},{"key":"pone.0358543.ref012","doi-asserted-by":"crossref","first-page":"102263","DOI":"10.1016\/j.pmedr.2023.102263","article-title":"Disparities in COVID-19 vaccine hesitancy among a diverse community-based sample in Connecticut, United States","volume":"34","author":"WH Eger","year":"2023","journal-title":"Prev Med Rep"},{"key":"pone.0358543.ref013","first-page":"100191","article-title":"County-level vaccination coverage and rates of COVID-19 cases and deaths in the United States: an ecological analysis","volume":"9","author":"JM McLaughlin","year":"2022","journal-title":"Lancet Reg Health Am"},{"issue":"3","key":"pone.0358543.ref014","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1080\/19475683.2022.2026474","article-title":"Assessment of disparities in spatial accessibility to vaccination sites in Florida","volume":"28","author":"K Kim","year":"2022","journal-title":"Ann GIS"},{"key":"pone.0358543.ref015","doi-asserted-by":"crossref","first-page":"182","DOI":"10.15585\/mmwr.mm7105a4","article-title":"Notes from the field: COVID-19 vaccination among persons living with diagnosed HIV infection \u2014 New York, October 2021","volume":"71","author":"JM Tesoriero","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0358543.ref016","unstructured":"US Census Bureau. ZIP Code Tabulation Areas (ZCTAs); 2022 [cited 2026 Jul 8]. Available from: https:\/\/www.census.gov\/programs-surveys\/geography\/guidance\/geo-areas\/zctas.html"},{"key":"pone.0358543.ref017","doi-asserted-by":"crossref","first-page":"922","DOI":"10.15585\/mmwr.mm7025e1","article-title":"COVID-19 vaccination coverage among adults \u2014 United States, December 14, 2020\u2013May 22, 2021","volume":"70","author":"J Diesel","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0358543.ref018","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.15585\/mmwr.mm695152e2","article-title":"The Advisory Committee on Immunization Practices\u2019 updated interim recommendation for allocation of COVID-19 vaccine \u2014 United States, December 2020","volume":"69","author":"K Dooling","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0358543.ref019","unstructured":"Florida Department of Health. COVID-19 Vaccine Summary: Vaccination Data Through April 30, 2021, as of May 1, 2021 at 12:05 AM. Tallahassee, FL; 2021. Available from: https:\/\/ww11.doh.state.fl.us\/comm\/_partners\/covid19_report_archive\/vaccine\/"},{"key":"pone.0358543.ref020","unstructured":"Centers for Disease Control and Prevention\/Agency for Toxic Substances and Disease Registry. CDC\/ATSDR Social Vulnerability Index 2020 Database, Florida; 2020 [cited 2023 Apr 17]. Available from: https:\/\/www.atsdr.cdc.gov\/place-health\/php\/svi\/svi-data-documentation-download.html"},{"key":"pone.0358543.ref021","unstructured":"U.S. Census Bureau. American Community Survey, 2016\u20132020 Five-Year Estimates Survey Data Tables; 2022 [cited 2026 Jul 8]. Available from: https:\/\/www.census.gov\/programs-surveys\/acs\/data\/data-tables.html"},{"key":"pone.0358543.ref022","unstructured":"U.S. Department of Agriculture Economic Research Service. Rural-Urban Commuting Area Codes | Economic Research Service; 2025 [cited 2026 May 27]. Available from: https:\/\/www.ers.usda.gov\/data-products\/rural-urban-commuting-area-codes"},{"key":"pone.0358543.ref023","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/QAI.0000000000003369","article-title":"Factors associated with COVID-19 vaccination among racial\/ethnic minority groups with HIV in South Florida","volume":"95","author":"D Ram\u00edrez-Ortiz","year":"2024","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"6","key":"pone.0358543.ref024","first-page":"599","article-title":"COVID-19 vaccine intentions and mistrust in a national sample of Black Americans","volume":"113","author":"LM Bogart","year":"2022","journal-title":"J Natl Med Assoc"},{"issue":"2","key":"pone.0358543.ref025","article-title":"A commentary on the Latin American paradox","volume":"3","author":"AF Abra\u00eddo-Lanza","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"10","key":"pone.0358543.ref026","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1177\/08982643231174980","article-title":"Latino mortality paradox found (again): COVID-19 mortality a tale of two years","volume":"35","author":"MA Garcia","year":"2023","journal-title":"J Aging Health"},{"issue":"3","key":"pone.0358543.ref027","article-title":"Hispanic mortality paradox: a systematic review and meta-analysis of the longitudinal literature","volume":"103","author":"JM Ruiz","year":"2013","journal-title":"Am J Public Health"},{"key":"pone.0358543.ref028","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciac508","article-title":"COVID-19 vaccination coverage, intentions, attitudes and barriers by race\/ethnicity, language of interview, and nativity, National Immunization Survey Adult COVID Module, April 22, 2021\u2013January 29, 2022","volume":"75","author":"EC Ohlsen","year":"2022","journal-title":"Clin Infect Dis"},{"issue":"12","key":"pone.0358543.ref029","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofad584","article-title":"Using a health information exchange to characterize changes in HIV viral load suppression and disparities during the COVID-19 pandemic in New York City","volume":"10","author":"E Tucker","year":"2023","journal-title":"Open Forum Infect Dis"},{"issue":"27","key":"pone.0358543.ref030","doi-asserted-by":"crossref","first-page":"4391","DOI":"10.1002\/sim.7501","article-title":"Practical recommendations for reporting Fine-Gray model analyses for competing risk data","volume":"36","author":"PC Austin","year":"2017","journal-title":"Stat Med"},{"key":"pone.0358543.ref031","doi-asserted-by":"crossref","first-page":"431","DOI":"10.15585\/mmwr.mm7012e1","article-title":"County-level COVID-19 vaccination coverage and social vulnerability \u2014 United States, December 14, 2020\u2013March 1, 2021","volume":"70","author":"MM Hughes","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358543","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:41:58Z","timestamp":1789753318000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358543"}},"subtitle":[],"editor":[{"given":"Kuo-Cherh","family":"Huang","sequence":"first","affiliation":[{"name":"Taipei Medical University","place":["TAIWAN"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0358543","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]}}}