Multilevel Drivers of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Among Black Philadelphians

Abstract

Background Unequal HIV/AIDS distribution is influenced by certain social and structural contexts that facilitate HIV transmission and concentrate HIV in disease epicenters. Thus, one of the first steps in designing effective community-level HIV/AIDS initiatives is to disentangle the influence of individual, social, and structural factors on HIV risk. Combining ethnographic methodology with geographic information systems (GIS) mapping can allow for a complex exploration of multilevel factors within communities that facilitate HIV transmission in highly affected areas. Objectives We present the formative comparative community-based case study findings of an investigation of individual-, social- , and structural-level factors that contribute to the HIV/AIDS epidemic among Black Philadelphians. Methods Communities were defined using census tracts. The methodology included ethnographic and GIS mapping, observation, informal conversations with residents and business owners, and secondary analyses of census tract-level data in four Philadelphia neighborhoods. Results Factors such as overcrowding, disadvantage, permeability in community boundaries, and availability and accessibility of health-related resources varied significantly. Further, HIV/AIDS trended with social and structural inequities above and beyond the community’s racial composition. Discussion This study was a first step to disentangle relationships between community-level factors and potential risk for HIV in an HIV epicenter. The findings also highlight stark sociodemographic differences within and across racial groups, and further substantiate the need for comprehensive, community-level HIV prevention interventions. These findings from targeted United States urban communities have potential applicability for examining the distribution of HIV/AIDS in broader national and international geosocial contexts.

Geospatial Indicators of Space and Place: A Review of Multilevel Studies of HIV Prevention and Care Outcomes Among Young Men Who Have Sex With Men in the United States

“…It is possible that the variation across studies may be ascribed to different historical and contextual characteristics not easily measured through quantitative markers and/or not necessarily replicable across communities. Similar to mixed-methods work carried out during the descriptive phase of community needs assessments (Brawner, Reason, Goodman, Schensul, & Guthrie, 2015), research examining how and under what conditions social characteristics are associated with the health and well-being of sexual minority communities in inferential studies is warranted.…”

Place Still Matters: Racial/Ethnic and Geographic Disparities in HIV Transmission and Disease Burden

“…While a city-wide analysis would have been ideal, resources available for the larger study restricted the timeintensive study activities to four census tracts. For the larger investigation, published elsewhere [24], we conducted a multimethod, comparative neighborhoodbased case study in four Philadelphia census tracts on individual-level, social-level, and structural-level factors that contribute to the HIV/AIDS epidemic among black Philadelphians. The larger study included engagement of key stakeholders and an in-depth community ethnography, including field visits, observation, and conversations with residents and business owners, in the four study areas.…”

“…Nearly two thirds of the city's cumulative HIV/AIDS cases are among blacks, and in 2014, the number of HIV cases among blacks was almost twice that of whites and Hispanics combined [23]. Brawner et al [24] identified overcrowding, disadvantage, permeability in neighborhood boundaries, and availability and accessibility of health-related resources as primary contributors to these disparities and heightened HIV/AIDS rates in the city. Additionally, Eberhart et al discovered that spatial patterns independently predicted hotspots for poor linkage to care, retention in care, and viral suppression in Philadelphia's HIV/AIDS cases [25].…”

The Role of Sexual Health Professionals in Developing a Shared Concept of Risky Sexual Behavior as it Relates to HIV Transmission

“…Several researchers have demonstrated associations between SES and high HIV prevalence (Auerbach, Parkhurst, & C aceres, 2011;Parkhurst, 2010). In geographic mapping studies, researchers have also discovered increased rates of HIV prevalence and high-risk behaviors in low-income neighborhoods (Brawner, Reason, Goodman, Schensul, & Guthrie, 2015;Nunn et al, 2014). Community stressors associated with living in poverty are associated with HIV risk behaviors (Kalichman, Simbayi, Jooste, Cherry, & Cain, 2005).…”