Social trust fosters timely HIV testing

June 6, 2017 | Press Releases & Announcements

Dr. Denis Nash

Dr. Denis Nash, professor at CUNY Graduate School of Public Health and Health Policy, and colleagues examined the relationship between higher social trust and lower late HIV diagnosis and mortality by race and ethnicity. The findings were published in the Journal of the International AIDS Society.

The research team performed generalized structural equation modeling to assess main and interaction associations between trust among one’s neighbors in 2009 (i.e. social trust) and race/ethnicity (Black, White, and Hispanic) predicting late HIV diagnosis (a CD4 count ≤200 cell/µL within three months of a new HIV diagnosis) rates and all-cause mortality rates of persons ever diagnosed late with HIV, across 47 American states for the years 2009-2013. The team examined potential indirect effects of state-level HIV testing between social trust and late HIV diagnosis. Social trust data were from the Gallup Healthways Survey, HIV data from the Centers for Disease Control and Prevention, and HIV testing from the Behavioral Risk Factor Surveillance System. Covariates included state-level structural, healthcare, and socio-demographic factors including income inequality, healthcare access, and population density. The research team stratified their analysis by transmission group: male-to-male, heterosexual, and injection drug use.

States with higher levels of social trust had lower late HIV diagnosis rates. Adjusted rate ratios were consistent across risk groups. Those associations differed by race/ethnicity. The associations were most protective for Blacks followed by Hispanics, and least protective for Whites. HIV testing mediated between 18 and 32 percent of the association between social trust and late HIV diagnosis across transmission group but for Blacks relative to Whites only. Social trust was associated with lower all-cause mortality rates and that association varied by race/ethnicity within the male-to-male and injection drug use transmission groups only.

The research team concluded that social trust may promote timely HIV testing, which can facilitate earlier HIV diagnosis, thus it can be a useful determinant to monitor the relationship with HIV care continuum outcomes especially for racial/ethnic minority groups disproportionately infected by HIV.


Ransome, Y., Batson, A., Galea, S., Kawachi, I., Nash, D., & Mayer, K. (2017). The relationship between higher social trust and lower late HIV diagnosis and mortality differs by race/ethnicity: results from a state-level analysis. Journal Of The International AIDS Society, 20(1). doi:10.7448/ias.20.1.21442