The Role of Individual and Neighborhood Factors: HIV Acquisition Risk Among High-Risk Populations in San Francisco

Abstract

We examined socioeconomic status and social and sexual network factors and their relationship to HIV acquisition risk among HIV-negative Black MSM (BMSM), White MSM (WMSM) and transfemales (male to female transgenders). Geographic analysis examined residential patterns and neighborhood patterns of HIV prevalence in San Francisco. Factors associated with engaging in more episodes of potentially HIV serodiscordant unprotected receptive anal intercourse were analyzed. Transfemales and BMSM were more likely to live in areas of higher HIV prevalence and lower income compared to WMSM. BMSM and transfemales had lower socioeconomic scores (SES) scores compared to WMSM. BMSM were more likely to report serodiscordant partnerships and higher numbers of potentially serodiscordant unprotected sex acts. Decreasing individual SES did not predict serodiscordant partnerships in any group. Increasing neighborhood HIV prevalence predicted an increase in the number of potentially serodiscordant unprotected sex acts among transfemales and BMSM but only significantly so for transfemales. Prevention interventions must consider neighborhood HIV prevalence, and HIV prevalence in social/sexual networks, in addition to considering individual level behavior change or poverty reduction.

Discrimination and Hate Crimes in the Context of Neighborhood Poverty and Stressors Among HIV-Positive African-American Men Who Have Sex with Men

“…14–16 Structural inequities are visible in neighborhood characteristics, such as quality housing, 17 access to employment and adequate wages, 18 availability of good schools, 19 crime, 10 and poverty. 14 HIV-positive African-American MSM often reside within disenfranchised neighborhoods with high poverty 15, 21, 22 and significant neighborhood-related stressors 23 (e.g., negative neighborhood conditions such as vandalism and litter). A qualitative study 24 highlighted that Black MSM’s lives are impacted by unemployment, racial discrimination, police surveillance/harassment, and incarceration.…”

Socioeconomic status and HIV vaccine preparedness studies in North America

“…To further complicate matters, SES interacts with race and ethnicity, as ethnic or racial groups are disproportionately represented in each SES stratum. In one study in men who have sex with men (MSM) in San Francisco in 2008, White MSM were more likely to have a college education or greater, have higher incomes, and have health insurance [4]. White MSM had the highest SES scores, while Black MSM and transfemales had similar, lower levels of SES.…”

Examining the Authors’ Choice of Secondary Data in Determining What Factors Affect HIV Prevalence in WMSM, BMSM and Transgender Populations

“…A second issue is that the authors made a conclusion that for BMSM, stimulant use appeared to be the strongest factor in risky sexual behaviour and HIV acquisition; however, since the BMSMs data came from a study that recruited black men who were injection drug users (IDUs) it is possible that there was an overestimate in the correlation between BMSMs, HIV prevalence and stimulant used [1].…”