Population Levels of Psychological Stress, Herpesvirus Reactivation and HIV

Abstract

Nearly 40,000 Americans are newly infected with Human Immunodeficiency Virus (HIV) each year. Recently, studies have demonstrated associations between group-level characteristics and the prevalence and incidence of HIV/Acquired Immune Deficiency Syndrome (AIDS) and other sexually transmitted diseases. Two mechanisms previously posited to explain these associations are neighborhood effects on risk behaviors and social or institutional policies. In this paper, we hypothesize that adversity at the population level, such as neighborhood poverty, also influences HIV risk through stress-mediated aberrations in immunological susceptibility by reviewing existing data examining each of these pathways. In particular, we review the evidence showing that: (1) Neighborhood ecologic stressors influence neighborhood-and individual-levels of mental health, psychosocial stress, and HIV/AIDS risk, (2) Individual-level psychosocial stressors influence progression from HIV to AIDS through stress-related hormonal changes, and (3) Individual-level psychosocial stressors influence HIV acquisition via stress-related reactivation of latent herpesviruses, specifically EBV and HSV-2. Our review indicates that further studies are needed to examine the joint pathways linking neighborhood-level sources of psychosocial stress, stress-related reactivation of HSV-2 and EBV, and increased acquisition rates of HIV. We suggest using a multi-level framework for targeting HIV prevention efforts that address not only behavioral risk factors, but structural, political, and institutional factors associated with neighborhood disadvantage, levels of psychosocial stress, and prevention or treatment of HSV-2 and EBV.

Neighborhood community characteristics associated with HIV disease outcomes in a cohort of urban women living with HIV

“…Since we adjusted for these factors, it is possible that neighborhood disorder also results in stress-related changes in immune functioning (Aiello et al, 2010; Shacham et al, 2013) as has been measured in other health and place studies by lower cortisol level and flatter rate of cortisol diurnal decline (Do et al, 2012; Karb et al, 2012), and by lower salivary telomere length (Theall et al, 2013). …”

Food Insecurity and Other Poverty Indicators Among People Living with HIV/AIDS: Effects on Treatment and Health Outcomes

“…More generally, lack of resources, daily stressors, and life disruptions that come with living in impoverished neighborhoods all potentially impede HIV treatment and health outcomes. (25, 26) Thus far, research has rarely examined multiple challenges of poverty in relation to treatment and health outcomes in people living with HIV.…”

Neighborhood Disadvantage and Changes in Condom Use among African American Adolescents

“…[4][5][6][7][8][9] The inclusion of macro-level indicators acknowledges that HIV/AIDS risk is not the sole result of individual-level characteristics but, rather, a reflection of how structural factors may shape behaviors and create health inequalities. 10,11 Increasingly, researchers have begun to assess how these structural factors are associated with HIV/AIDS risk behaviors in order to create multilevel HIV/STI prevention programs that go beyond traditional, individual-level behavior change efforts.…”