Intersectional Determinants of HIV Disparities Between African Americans and Caucasians in the United States: A Negative Binomial Regression Analysis

Abstract

HIV continues to disproportionately affect African Americans in the United States, reflecting persistent racial, socioeconomic, and healthcare inequities. While prior research has identified key determinants of HIV outcomes, limited studies have examined how these factors interact simultaneously. This study applies an intersectionality framework to assess how gender, age, income, and healthcare access jointly influence HIV disparities between African Americans and Caucasians. This study employed a quantitative research design using secondary data from the CDC spanning 2000–2023. A Negative Binomial Regression model was utilized to analyze overdispersed count data on HIV prevalence. The model incorporated main effects (gender, age, income, healthcare access, and socioeconomic status) and higher-order interaction terms to capture intersectional influences. Descriptive statistics and regression analyses were conducted to compare outcomes between the African American and Caucasian populations. Findings reveal significant racial disparities in HIV outcomes, with African Americans experiencing substantially higher prevalence rates than Caucasians. Main effects indicate that gender, age, income, and healthcare access are significant predictors of HIV exposure (p < .001). Specifically, African American males, females, and children are over three times more likely to be affected compared to their Caucasian counterparts. Higher income and improved healthcare access demonstrate protective effects, reducing HIV risk by 3.9% and 76%, respectively. Interaction analyses further show that combinations such as income × healthcare access and gender × income significantly reduce HIV exposure, highlighting the importance of intersectional dynamics. Intersectional factors play a critical role in shaping HIV disparities in the United States. Policies aimed at reducing HIV burden must address overlapping social and structural inequalities, particularly by improving economic conditions and healthcare access among vulnerable populations.

KEYWORDS: HIV disparities; Intersectionality; Negative binomial regression; African Americans; Healthcare access; Caucasians; Socioeconomic factors

DOI: 10.7176/JHMN/120-05

Publication date: April 30th 2026