Community Engaged Research to Advance Oral Health Intervention Models for Racial/Ethnic Minority HIV/AIDS Populations

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  1. Goal
  2. Background
  3. Gaps and Opportunities
  4. Specific Areas of Interest
  5. References

Oral Health Disparities and Inequities Research Program
Center for Clinical Research
Division of Extramural Research

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Goal

The objective of this initiative is to support community-engaged research (CEnR) projects to enhance effectiveness and equity of HIV/AIDS and oral health intervention models for racial and ethnic minorities living with HIV/AIDS or at risk for acquiring HIV in the United States.

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Background

According to the data from the CDC, there are nearly 1.2 million people living with HIV in the United States and dependent areas. While new HIV infections have decreased in recent years, HIV diagnoses, access to and outcomes of HIV care are affected by the complex interaction between individual’s race/ethnicity, other social identities, and systems of inequality. In 2022, the rate of HIV incidence among non-Hispanic Black persons (34.1 per 100,000 population) was nearly eight times the rate for non-Hispanic White persons (4.4). Using the HIV care continuum framework, the prevalence of HIV care receipt and viral suppression in people aged 13 years and older living with HIV (diagnosed or undiagnosed) were the lowest among American Indian/Alaska Native people (59% and 50% vs. overall 66% and 57%, respectively). Among men who have sex with men (MSM) with diagnosed HIV at year-end (N=593,383), fewer Hispanic/Latino and Native Hawaiian or other Pacific Islander men received HIV medical care than overall MSM with HIV diagnosis (75% vs. overall 78%), while non-Hispanic Black men had the lowest prevalence of viral suppression at most recent test (62% vs. overall 68%).

Disparities in dental care access and oral health outcomes also exist by race and ethnicity in the United States. According to the Medical Expenditure Panel Survey (MEPS) data from 2021, an estimated 39% of adults aged 19 to 64 saw a dentist, while 28% of non-Hispanic Black and 23% of the Hispanic population had a dental visit in the previous year. Among people 65 years and older, the gap was even larger with 56% vs. 30% of non-Hispanic White and non-Hispanic Black or Hispanic/Latino seniors having had a dental visit in the past year, respectively. In addition, according to the 2015‒2018 National Health and Nutrition Examination Survey (NHANES) data, non-Hispanic Black adults 65 years and older experienced a higher prevalence of complete tooth loss (25.4%) than Hispanic/Latino (15.3%) and non-Hispanic White (10.9%) older adults in the U.S., indicating disproportionate disease burden in these racial and ethnic minority populations. Data from the 2022 Indian Health Service Oral Health Survey indicate higher prevalence of untreated caries, severe periodontal disease, tooth loss, and perceived poor oral health among American Indian/Alaska Native adult dental patients than general U.S. population.

Oral conditions such as xerostomia, periodontal disease, ulcers, oral warts, candidiasis, and hairy leukoplakia are some of the first clinical signs that may appear in individuals with HIV infection. Furthermore, long-term use of antiretroviral therapy or Pre-Exposure Prophylaxis (PrEP) has been linked to adverse oral health effects such as hyposalivation. Despite the heightened needs and risk for oral health problems, dental care utilization among people living with HIV/AIDS or at risk of HIV is often compounded by various HIV-related and unrelated barriers. Consequently, it has been reported that unmet dental care needs are more than twice as prevalent as unmet medical care needs among people living with HIV/AIDS.

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Gaps and Opportunities

There are two NIDCR-funded projects solicited through FY21 HIV/AIDS Research Initiative (RFA-DE-21-002) that are currently testing strategies to incorporate HIV diagnosis, treatment, and prevention in dental settings. The optimal model of care delivery for HIV/AIDS populations, especially racial and ethnic minorities, may benefit from consideration of wider community-based approaches that address social determinants of health, psychosocial barriers, previous experience, preference, and unique needs of those affected by HIV/AIDS across the lifespan. HIV-related stigma, bias, racism, and discrimination for people of color, immigrants and/or with language barriers are among the structural and interpersonal determinants/barriers that may impact the access to and outcomes of HIV/AIDS and oral health care among racial and ethnic minority populations living with or at risk of HIV. Furthermore, it is estimated that the percentage of older adults in populations living with HIV in the U.S. will increase above 70% by 2030. Older persons with HIV are at risk for multiple chronic diseases and conditions, including dementia, conditions related to polypharmacy, and unmet social needs. To optimize the model of HIV/AIDS and oral health interventions that improve overall and oral health and well-being of people living with or at risk of HIV, engagement and cross-sectoral partnerships with communities affected by HIV/AIDS and holistic approaches are essential at every stage of HIV/AIDS research and intervention efforts. 

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Specific Areas of Interest

This initiative responds to Fiscal Year 2026 NIH HIV/AIDS Professional Judgment Budget document which calls to address HIV/AIDS health disparities and inequities for the first time. The population/community of interest for this initiative is racial and ethnic minorities living with or at risk of HIV, and the potential applicants should demonstrate strategies for equitable and sustainable partnerships with the target population/community and existing effort/resources (e.g. AIDS research community engagement cores/advisory group and/or relevant community-based organizations) in the proposal in addition to scientific project proposal. The areas of research interest include but are not limited to:

  • Studies to understand multi-level barriers and facilitators for HIV/AIDS and oral health interventions by paying attention to intersectionality.
  • Studies to test feasibility, acceptability, and/or effectiveness of non-traditional point of entry for interventions related to HIV/AIDS and oral health screening and coordination of knowledge and services.
  • Studies that address structural racism and social determinants of health affecting HIV/AIDS and oral health care access and/or outcomes .
  • Studies to assess communication and engagement strategies for equitable uptake of evidence-based interventions and sustainable behavior changes to prevent HIV/AIDS comorbidities including oral and dental diseases.
  • Studies to assess the model of oral health care and social support integration in Health Resources and Services Administration Ryan White program sites.
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References

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Last Reviewed
September 2024