Association Between HIV Risk and Health Care Access Among U.S. Adults in the South: Insights from the 2022 Behavioral Risk Factor Surveillance System

In the United States (U.S.), the highest burden of new HIV diagnosis continues to occur in Southern states. Healthcare access among at-risk populations is crucial to mitigate HIV transmission, yet data on the association between HIV risk and healthcare access is limited. This study examined the association between HIV risk, (i.e., injecting any drug other than those prescribed, engaging in transactional sex, receiving treatment for a sexually transmitted infection, having condomless anal sex, or having four or more lifetime sexual partners-all within the past year) and healthcare access among adults in the South, adjusting for covariates. The 2022 Behavioral Risk Factor Surveillance System for Southern states was analyzed, and 191,266 respondents participated. Rao-Scott Chi-square tests and weighted logistic regression analyses using complex sampling design were performed in SAS v. 9.4. Findings suggest that U.S. adults in the South at risk for HIV had higher odds of not having health insurance coverage (OR=1.55; 95% CI: 1.34-1.79), not having a personal doctor (OR=2.00; 95% CI: 1.78-2.25), delaying routine check-ups for a year or more (OR=1.75; 95% CI: 1.57-1.96), and being unable to afford medical care in the past year (OR=2.26; 95% CI: 2.00-2.56), compared to those not at risk, for unadjusted analyses. After adjusting for covariates, findings suggest that adults in the South at risk for HIV had 1.69 higher odds of being unable to afford medical care in the past year due to financial constraints (95% CI: 1.45-1.97) compared to those not at risk. Among adults at risk for HIV in the South, enhancing access to HIV preventive services, particularly during public health emergencies, has the potential to mitigate HIV transmission risks and reduce the associated financial burden. This association warrants reevaluation in the post-pandemic era to guide future prevention efforts effectively.