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Methodologies to Enhance Understanding of HIV-Associated Social Determinants

NAMHC Concept Clearance

Presenter

Dianne Rausch, Ph.D.
Director, Division of AIDS Research

Goal

This initiative aims to support formative work and methodological innovations to build effective interventions that will address or mitigate the impact of social determinants that drive negative HIV-related outcomes. Mechanisms that may underlie these social determinants include factors at individual, social, and cultural levels.

Rationale

Social determinants are defined as overlapping social and economic factors that influence health (WHO, 2010), and are important, but under-investigated, in their contribution to health risk and resilience. Agencies including the WHO and the U.S. Centers for Disease Control and Prevention have initiated efforts that emphasize the importance of addressing social determinants in order to reduce health disparities and achieve health equity.

Significant health disparities exist for HIV disease in the U.S., and there is mounting evidence of the importance of social and economic factors for both individual and community health outcomes. For example, socio-economic factors--such as homelessness, lack of employment, and a lack of high school education--are all associated with HIV infection in U.S. cities with high AIDS prevalence. However, less is known about how to intervene in order to change the relationship between these social determinants and negative HIV-associated outcomes. This may be due, in part, to the fact that although the majority of evidence to date demonstrates associations between social determinants and health, less is known about the mechanisms underlying social determinants, including how they are interrelated and how they operate. In addition, little is known as to why some individuals--despite being exposed to the same social determinants--are not significantly negatively impacted (e.g., resilience). Filling in these research gaps is fundamental to the development of effective structural-level interventions that directly address social determinants.

Mechanisms that may underlie social determinants could include, but are not limited to, psychosocial/individual (e.g., efficacy, coping), social/interpersonal (e.g., social capital, culture), systems/community (e.g., institutionalized racism, policies).

This initiative calls for basic social research to:

  • Develop new or utilize existing methods to better characterize the mechanisms that underlie social determinants.
  • Identify individual and/or community-level mechanisms (e.g., coping, social networks) associated with positive health outcomes despite exposure to negative social, economic and/or legal conditions.
  • Identify resilience factors, as distinct from risk factors.
  • Develop or enhance measurement techniques that ensure research studies can accurately capture the mechanisms that underlie social determinants.
  • Utilize complex datasets and data analytic techniques to understand the contribution of multiple social determinants to HIV-related outcomes in both similar and distinct populations.
  • Utilize existing or develop new rigorous methodology to allow capturing of the most useful observational data, which will inform future research directions.

Applicants are encouraged to include in their applications multi-disciplinary teams. Specifically, teams should draw on expertise in other health conditions, in addition to expertise outside of the health field could be applied to HIV, for example in disciplines such as social and behavioral economics, urban planning, systems management, and demography.

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