Social Stability and HIV Risk Behavior: Evaluating the Role of Accumulated Vulnerability

Abstract

This study evaluated a cumulative and syndromic relationship among commonly co-occurring vulnerabilites (homelessness, incarceration, low-income, residential transition) in association with HIV-related risk behaviors among 635 low-income women in Baltimore. Analysis included descriptive statistics, logistic regression, latent class analysis and latent class regression. Both methods of assessing multidimensional instability showed significant associations with risk indicators. Risk of multiple partners, sex exchange, and drug use decreased significantly with each additional domain. Higher stability class membership (77%) was associated with decreased likelihood of multiple partners, exchange partners, recent drug use, and recent STI. Multidimensional social vulnerabilities were cumulatively and synergistically linked to HIV risk behavior. Independent instability measures may miss important contextual determinants of risk. Social stability offers a useful framework to understand the synergy of social vulnerabilities that shape sexual risk behavior. Social policies and programs aiming to enhance housing and overall social stability are likely to be beneficial for HIV prevention.

Prevalência e vulnerabilidade à infecção pelo HIV de moradores de rua em São Paulo, SP

“…It might be consequential to the extreme vulnerability that is inherent to living on the streets, 1,15,28 and such a condition overlaps with other factors typically associated with poverty and social inequality in the general population. In other words, living on the streets and insecurity related to having no housing 7,11,20,28 are per se factors that bring about situations of greater exposure to HIV such as violence and no access to services. 14,26,29 These same particularities may largely explain the study fi nding that young, female and homeless individuals engaging in homosexual sex are more vulnerable to HIV infection.…”

“…All these factors strongly affect homeless people in Brazil, 3,a,b and in other countries. 7,11,16,20 Studies assessing the impact of the HIV/AIDS epidemic on homeless people are scarce in Brazil. 2,3,b There is little information on HIV prevalence rates, risk factors associated with HIV infection, and other aspects that may guide specifi c prevention actions in this group.…”

Vulnerabilidade, empoderamento e conhecimento: memórias e representações de enfermeiros acerca do cuidado

“…For presenting a well branded representational field, positive or negative attitudes and a body of consolidated knowledge, vulnerability and empowerment present themselves as objects of representation, such as have been explored by other authorsFurthermore, this study reinforced the assumption that fragilities, which touch the human being, particularly the nurse when providing care to other human beings in vulnerable situations, were answered with attitudes, knowledge and practices whose goal was to move the subjects to a more favorable context, in which a greater degree of empowerment could be achieved. (1)(2)(3)(4)(5)(6)(7)(8)9,(11)(12)(13)(14)(15)(16) Data highlight that knowledge maintains interfaces with vulnerability, with empowerment, with social representations of AIDS and of nursing care for patients with HIV. Even when dealing with distinct objects of representation, it is postulated that there was an intertwining of them, of complex configurations, and that it was susceptible to transformations consonant with interpersonal relationships among the social actors involved in daily healthcare and, more broadly, the geopolitical injunctions related to the AIDS phenomenon.…”

“…This data corroborates findings of other research. (5)(6)(7)8) However, the time in professional practice in the HIV/Aids area, the growing interest in a disease process that generates dependency in multiple domains of the human being, and acquisition of scientific knowledge available to the subjects over the years, especially in the media and professional courses offered by the institution, contributed to acceptance by the nurses, of the activity of providing healthcare to patients who were HIV seropositive, which embodied the representational content about a more favorable state of empowerment. In this direction, the search for knowledge, the increased interest in AIDS, and time of practice in this context (most of the subjects had 16 or more years of experience) were elements present in the representational construction of subjects as opponents to the power of fear, based on uncertainty and imminence of the perceived risk of contamination.…”

“…In the last years, conceptual prepositions of vulnerability have expressed facets that emphasize the social context of population groups, (2)(3)(4)(5)(6) not considering their quantifiable aspects that could potentially produce the illness.…”