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The legacy of discriminatory housing policies continues to shape both economic and health outcomes. A study by Tulane University, New Orleans, published in JAMA Internal Medicine, reveals that patients in historically redlined neighborhoods experience significantly longer delays in achieving HIV viral suppression than those in non-redlined areas.

Researchers analyzed 1132 newly diagnosed patients with HIV in New Orleans between 2011 and 2019, finding a 15% longer delay in viral suppression among those from redlined neighborhoods. These delays impact both individual health and broader public health efforts to prevent HIV transmission, said senior author Scott Batey, PhD, a professor at Tulane’s School of Social Work, New Orleans.

“The association between redlining and health outcomes is not a new concept, but applying this lens specifically to HIV was novel,” Batey noted.

Though HIV viral suppression can be achieved in about a month with a single daily pill, the study found it took patients from redlined neighborhoods nearly a month longer to achieve it than their counterparts (193 vs 164 days). The study was conducted in collaboration with the Louisiana Department of Health and the University of Alabama at Birmingham, Alabama. 

‘Structural Determinants of Health’

Abolished in 1968, redlining refers to the practice of mortgage lenders marking certain areas with red lines on maps to signify where loans would be denied to residents based on their race or ethnicity. This financial exclusion led to lasting disparities in healthcare access, education, and household income.

Today, even in areas where investments have been made to counteract redlining, “individuals still experience longer times to achieve viral suppression,” Batey said. “This suggests that historical systemic barriers continue to have lingering effects, even across generations.”

Among the study participants, 62% resided in formerly redlined neighborhoods. Most were men between ages 25 and 44 years. Although New Orleans has a Black majority population, the study revealed a higher concentration of Black individuals in redlined areas than in non-redlined ones.

“Our study reinforced existing research that links social determinants of health — such as poverty, depression, substance abuse, and intimate partner violence — to HIV outcomes,” he added. “However, structural determinants of health remain less explored, making our findings particularly compelling.”

Factors like limited healthcare access, financial insecurity, transportation barriers, and medical mistrust further delay treatment, Batey said. Limited health literacy and stigma further complicate access to timely care. “Stigma remains a major barrier — people may avoid seeking care due to fear of discrimination.”

While the study focused on New Orleans, its findings are relevant across the Deep South, where redlining was prevalent and healthcare disparities persist. This region accounts for over half of new HIV cases in the United States, Batey said.

Addressing these systemic issues requires targeted interventions. “If we can make services more accessible and get people virally suppressed sooner, the impact on the HIV epidemic could be profound,” Batey said. “Expanding on-site testing and at-home testing, telehealth options, and culturally competent education initiatives can help close these healthcare gaps.”

Collaboration in the Community

The results from the redlining study can help inform and reinforce the need for community-based strategies. A multidisciplinary approach is essential to addressing HIV treatment adherence, added Shobha Swaminathan, MD, FIDSA, professor of medicine and director of HIV services at Rutgers New Jersey Medical School.

“Most infectious disease physicians enter their specialty driven by a strong desire to improve public health and reduce health disparities,” said Swaminathan, who also serves as medical director of Infectious Diseases Practice, Rutgers Health at University Hospital. “This foundational motivation is a powerful asset in addressing the complexities of HIV treatment adherence.”

By collaborating with mental health and substance use disorder clinicians, community health workers, and case managers, providers can deliver patient-centered care while increasing education on HIV treatment effectiveness. Encouraging the use of long-acting injectable medications can also help address adherence challenges, Swaminathan said.

Education campaigns, community outreach, and partnerships with local organizations — especially through social media — can inform at-risk populations about early treatment and viral suppression, she added. Integrated care models that address HIV alongside mental health and substance use concerns can improve retention, with local services easing access to multiple types of care.

Community health worker programs and long-acting injectable antiretrovirals offer promising solutions, reducing the burden of daily medication and improving engagement in care, Swaminathan said.

“By approaching HIV care with a comprehensive, empathetic, and advocacy-driven mindset, we can be catalysts for change in the fight against HIV, improving both individual and community health outcomes.”

Batey and Swaminathan reported having no relevant financial relationships.