The intersection of place and health: neighborhood and socioeconomic factors associated with viral suppression.

Despite the availability of resources such as Ryan White-funded clinics, which provide free/low-cost HIV care services, significant disparities in viral suppression rates exist. This study investigates whether neighborhood characteristics and socioeconomic factors are associated with viral suppression rates among people with HIV (PWH) in Southern California neighborhoods with Ryan White clinics. Forty Southern California zip codes with a combined estimated population of 1.4 million were analyzed. Beta regression models were used to assess neighborhood characteristics and socioeconomic factors associated with the proportion of PWH who are virally suppressed per zip code. Neighborhoods with a higher public transit score, safety score, and Healthy Places Index score had greater proportions of PWH who were virally suppressed. Longer average commute times, higher poverty rates, lack of health insurance, and higher average hours of work per week were negatively associated with viral suppression. Additionally, no association was found between the proportion of PWH who are virally suppressed and neighborhood walkability score, educational attainment, and employment. Findings highlight the need for tailored interventions that address specific community needs. The presence of HIV treatment services may not ensure access or uptake, underscoring the importance of addressing socioeconomic and local structural contexts.