State Variation in HIV/AIDS Health Outcomes: The Effect of Spending on Social Services and Public Health
OBJECTIVE:
Despite
considerable advances in the prevention and treatment of HIV/AIDS, the
burden of new infections of HIV and
AIDS varies substantially across the country. Previous studies have
demonstrated associations between increased healthcare spending and better HIV/AIDS
outcomes; however, less is known about the association between spending on
social services and public health spending and HIV/AIDS
outcomes. We sought to examine the association between state-level spending on
social services and public health and HIV/AIDS case rates and AIDS deaths across the
United States.
DESIGN:
We
conducted a retrospective, longitudinal study of the 50 U.S. states over
2000-2009 using a dataset of HIV/AIDS case rates and AIDS deaths per 100 000
people matched with a unique dataset of state-level spending on social services
and public health per person in poverty.
METHODS:
We
estimated multivariable regression models for each HIV/AIDS
outcome as a function of the social service and public health spending 1 and 5
years earlier in the state, adjusted for the log of state GDP per capita, regional
and time fixed effects, Medicaid spending as % of GDP, and socio-demographic,
economic, and health resource factors.
RESULTS:
States
with higher spending on social services and public health per person in poverty
had significantly lower HIV and
AIDS case rates and fewer AIDS deaths, both 1 and 5 years post expenditure (P ≤
0.05).
CONCLUSION:
Our
findings suggest that spending on social services and public health may provide
a leverage point for state policymakers to reduce HIV/AIDS case
rates and AIDS deaths in their state.
- 1Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
- AIDS. 2016 Feb 20;30(4):657-63. doi: 10.1097/QAD.0000000000000978.
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