The Association Between Social Determinants of Health and HIV Risk Behaviors and HIV Testing Among Sexual and Gender Minority Individuals: A National Survey Study

Social determinants of health (SDOH) predispose Sexual and Gender Minority (SGM) individuals to HIV infection through risky behaviors and less HIV testing. This study used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey to evaluate the association between composite measures of SDOH and HIV risk behaviors and HIV testing among adult SGM population in the US. SGM individuals were identified through two questions that asked about respondents' sexual orientation and gender identity. Two primary outcomes of interest were HIV testing behavior and HIV risk behavior. SDOH was measured by ten items which were summed to get a composite score, where a higher score indicates a worse social disadvantage. Logistic regression models were used to examine the association of SDOH composite score with HIV risk behaviors and HIV testing. Among 10,774 SGM individuals who provided responses to the HIV testing question, 5,696 (52.87%) reported lifetime HIV testing. For the HIV risk behavior question, 10,736 SGM individuals responded, of whom 2,059 (19.18%) reported engaging in HIV risk behaviors. SGMs with more social disadvantages were more likely to engage in HIV risk behaviors (Adjusted Odds ratio (AOR) = 1.15, 95% Confidence interval (CI) = 1.12, 1.19) and have a high likelihood of HIV testing (AOR = 1.09, 95% CI = 1.06, 1.12) compared with those with less social disadvantages. A high composite SDOH score is associated with increased HIV risk behaviors and high HIV testing among SGM individuals. Reducing the HIV burden among the SGM population requires addressing structural factors through multifaceted approaches.