For Persons Living With HIV, Transportation Barriers Adversely Affect HRQOL

As a social determinant of health, transportation barriers and their impact on health-related quality of life (HRQOL) were investigated among persons living with HIV in the Deep South.

Worsened health outcomes among persons living with HIV in the Deep South region of the United States have been linked to transportation barriers, according to new study findings published in AIDS and Behavior.

The Deep South encompasses Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas, and between 2012 and 2017, 82% of new HIV diagnoses in the South were within this area, the authors noted.

Overall, they considered the effects of sociodemographics, HIV characteristics, depressive symptoms, health-related quality of life (HRQOL), and perceived transportation barriers on health perceptions, pain, social functioning, health distress, and health transitions. Most study participants (N = 261) were African American (80.1%) and identified as male (64.4%); persons were excluded if they had a preexisting neuromedical condition (eg, Alzheimer disease, schizophrenia, or traumatic brain injury). Close to 80% also had an annual income, before taxes, of $20,000 or less, and median (interquartile range) years since HIV diagnosis were 18 (10.8-24.0).

“Access to adequate transportation is a social determinant of health that is frequently overlooked in aging and public health research, as previous transportation-related studies have primarily focused on motor vehicle safety outcomes and indicators of driving abilities within aging samples,” the authors wrote when providing the impetus for their study of outcomes among persons aged 39 to 73 years (mean [SD] age, 51.10 [6.78] years). “Access to reliable transportation is a social determinant of health imperative for disease management for those aging with HIV/AIDS.”

Outcomes in connection with transportation show that just 63.6% had a valid driver’s license, 67.8% owned or could access a vehicle, 37.5% cancelled/missed appointments because they did not have transportation, and 61.3% reported their transportation needs often dictated their health care scheduling. An overwhelming majority (88.5%) highlighted the importance of adequate transportation to QOL improvement.

In particular, 13.4% noted they had slight problems accessing care; 13.4%, somewhat of a problem; and 5.7%, major problems. The demographics of non-White race, lower household income, and fewer total education years were found to be associated with vehicle nonownership or access, health care planning around transportation availability, and perceived transportation barriers.

Lower household income alone was potentially linked to not owning or having access to a vehicle (P < .001), cancelled/missed health care appointments because transportation was not an option (P < .001), planning appointments around transportation needs (P < .001), greater perceived transportation barriers (P =.004), poorer medication adherence (P = .040), and greater depressive symptoms (P = .001).

Further, perceived transportation barriers indicated a higher risk of not owning or having access to a vehicle (P < .001), appointment cancellation due to lack of transportation (P < .001), having to plan health care appointments around transportation needs (P < .001), poorer medication adherence (P = .006), greater depressive symptoms (P < .001), and higher viral load (P = .016).

Additional study findings show that 51% of the study cohort was shown to be at high risk of depression, 94.7% with complete clinical data were currently on an antiretroviral treatment regimen, 66.4% had an undetectable viral load, and the current median T-cell count was 636.0 (382-882) cells/mm3.

Overall, for every unit increase in perceived transportation barriers, independent associations were seen for worsened scores for general health perceptions (–4.59; 95% CI, –7.97 to –1.21), pain (–5.41; 95% CI, –9.32 to –1.50), social functioning (–4.37; 95% CI, –8.34 to –0.39), health distress (–3.59; 95% CI, –6.84 to –0.34), and health transitions (­–4.36; 95% CI, –7.69 to –1.03).

They recommend that health care providers readily evaluate transportation needs and potential barriers among their patients living with HIV—especially those of an older age who may not have a license, cannot drive because of medical reasons, or live in areas that lack adequate public transportation—paying particular attention to how the ongoing stigma around HIV and AIDS may contribute.

“Implications involve a thorough health care assessment of transportation options and barriers when working with HIV/AIDS clinical samples,” the authors concluded, “along with further discussion into how public health approaches can be integrated into traffic safety policy and design to reduce systemic inequities that contribute to transportation barriers and health-related outcomes.”


Pope CN, Stavrinos D, Fazeli PL, Vance DE. Transportation barriers and health-related quality of life in a sample of middle-aged and older adults living with HIV in the Deep South. AIDS Behav. Published online January 23, 2022. doi:10.1007/s10461-021-03560-x

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