In the United States, people living with HIV (PWH) who develop cancer face unique and complex challenges in receiving timely and effective treatment. A groundbreaking study published in BMC Cancer has now shed light on the multifaceted social determinants that influence disparities in the receipt of cancer therapy among this vulnerable population. Drawing upon data collected between 2004 and 2020, the research reveals how race, ethnicity, and community-level socioeconomic factors interplay to affect cancer treatment access and utilization for PWH.
The study analyzed a comprehensive cohort of over 31,000 adult patients living with HIV and diagnosed with one of the fourteen most common cancers affecting this group. These included malignancies such as lung cancer, diffuse large B-cell lymphoma, colorectal cancer, and prostate cancer—diseases known to bear a disproportionate burden among people affected by HIV. The researchers aimed to understand not just clinical variables but also the social and environmental influences that might act as barriers to receiving first-line cancer treatments such as surgery, systemic therapy, hormone therapy, and radiotherapy.
One of the most striking findings was the tangible impact of area-level education on treatment receipt. Patients residing in neighborhoods where a higher percentage of adults lacked a high school diploma were significantly less likely to receive cancer therapy. Adjusted analyses showed that those in the lowest educational quartile had a 26% lower odds of undergoing treatment compared to individuals living in the highest quartile regions. This suggests that educational disparities contribute independently to inequities in cancer care among PWH.
Similarly, median household income within a patient’s residential zip code emerged as a powerful predictor of whether cancer treatment was initiated. Patients living in lower-income areas demonstrated a comparable 27% reduction in the likelihood of receiving therapy compared to those living in wealthier communities. These findings underscore systemic economic inequalities that may restrict access to healthcare resources, transportation, and supportive services integral to managing complex diseases like cancer.
Racial disparities were also a critical dimension of this investigation. Approximately 38% of the study population identified as non-Hispanic Black (NH-Black), and analyses were stratified to compare disparities within racial groups. Encouragingly, the inverse associations between social disadvantage indicators and treatment receipt were consistent across both NH-Black and non-Hispanic White populations, indicating that socioeconomic status rather than race per se may be the primary driver of reduced treatment uptake in these groups.
Beyond socioeconomic indicators, the type of cancer treatment facility was another influential factor. Patients treated at community cancer programs, as opposed to academic or research hospitals, were significantly less likely to initiate cancer therapy. This reveals potential gaps in resource availability, clinical expertise, and multidisciplinary care models between different facility types, which could exacerbate outcomes among PWH who are already at elevated risk for cancer-related complications.
Geographic proximity to cancer care emerged as yet another barrier. Those living within two miles of their treating cancer center were paradoxically less likely to receive treatment than patients residing more than 45 miles away. This counterintuitive result may reflect complex dynamics such as urban healthcare deserts, competing social priorities, or differences in healthcare navigation and patient advocacy services. Further research is warranted to disentangle these factors.
The research team employed hierarchical multivariable logistic regression models to control for confounding variables, reinforcing the robustness of the observed associations. Their models accounted for insurance status and distance to care, elements critical in understanding healthcare access. The finding that insurance coverage was included in analyses highlights the importance of evaluating both individual-level and structural determinants of health.
An important element of the study is its focus on PWH, a group traditionally underrepresented in cancer disparities research. Despite decades of improvements in HIV care and survival, PWH remain at increased risk for certain cancers and experience worse outcomes post-diagnosis. This research fills a critical knowledge gap by quantifying how social determinants intersect with race and ethnicity to influence cancer treatment receipt specifically in this population.
Clinically, this study raises alarms regarding potential delays or omissions in therapy that may worsen prognosis among PWH with cancer. The findings emphasize the necessity of targeted interventions that address both educational and economic disparities at the community level. Healthcare systems may need to implement programs that facilitate cancer care navigation, patient education, and support services tailored to socially disadvantaged patients with HIV.
Furthermore, the association between cancer care facility type and treatment receipt highlights an urgent need to strengthen the capacity and resources of community cancer programs. Enhancing training, multidisciplinary collaboration, and access to clinical trials at these facilities could help reduce the inequities identified. This is especially pertinent for underserved populations who are more likely to receive treatment in non-academic settings.
Policy implications are notable as well. The intertwining of social determinants with cancer treatment access suggests a call for broader integration of social services and public health initiatives within oncology care delivery. Addressing structural barriers like educational attainment and poverty requires multi-sectoral collaboration beyond healthcare alone.
The geographic findings provoke further inquiry into how urban-rural disparities and neighborhood-level factors influence cancer care among PWH. Tailored strategies informed by place-based data could optimize resource allocation and patient outreach efforts, particularly in regions like the Southern United States where a large proportion of the study population resides.
This research ultimately serves as a potent reminder that health disparities in cancer care are multifactorial and deeply rooted in social inequities. For PWH—a group striving not only to survive HIV but also to live well with cancer—the recognition and remediation of these determinants are paramount to achieving equitable outcomes.
As we consider the future of oncology and HIV care integration, studies like this illuminate pathways for intervention that transcend traditional biomedical approaches. Harnessing data on social determinants can guide precision public health measures and ultimately save lives.
In summary, this seminal work documents that social disadvantage at the community level, reflected in education, income, facility type, and geographic access, plays a significant role in whether people living with HIV receive cancer treatment in the United States. Recognizing and addressing these disparities will be vital to improving cancer care equity and outcomes for PWH nationwide.
Subject of Research: Social determinants of health and racial/ethnic inequities in cancer treatment receipt among people living with HIV in the U.S.
Article Title: Inequities by race and ethnicity in cancer treatment receipt among people living with HIV and cancer in the U.S. (2004–2020)
Article References:
Islam, J.Y., Guo, Y., McGee-Avila, J.K. et al. Inequities by race and ethnicity in cancer treatment receipt among people living with HIV and cancer in the U.S. (2004–2020). BMC Cancer 25, 897 (2025). https://doi.org/10.1186/s12885-025-14272-z
Image Credits: Scienmag.com
