How Do Neighborhood Resources Influence HIV Management?

Introduction: Epidemiologic data suggest that geographic clustering of new HIV infections is a common phenomenon, particularly in urban areas among populations of low socioeconomic status. As HIV management has been identified as an integral component of secondary prevention, better understanding of multi-level factors that influence medication adherence and related prevention behavior is necessary to interrupt poor HIV management and persistent incident infections. This study was conducted to assess the relationships between neighborhood conditions and engagement in transmission risk behaviors.

Methods: During routine outpatient HIV clinic visits, 1114 individuals from the St. Louis metropolitan area completed behavioral assessments as standard of care in 2011 and biomedical markers were abstracted from their medical records. Additionally, home addresses, clinic location, alcohol- and condom-selling establishments were geocoded. These data were spatially analyzed to identify the magnitude of the relationships between the studied behaviors and neighborhood resources.

Results:  Of the 1114 individuals presenting for care, the majority of the sample was African American and male, with a mean age of 42 years. Additionally, approximately 75% of the sample had current prescription to antiretroviral therapy with 68% having suppressed viral loads. We found that individuals who lived in census tracts with more alcohol selling establishments reported drinking higher amounts of alcohol weekly.  Neighborhoods with more HIV cases had fewer condom selling outlets; and among businesses that sold condoms, more stores sold them out in the open rather than behind the counter.

Conclusions: Previously, we have identified that individuals with HIV who were living in poorer neighborhoods reported higher rates of depression and unsuppressed viral loads. These analyses identified patterns of neighborhood resources that may be detrimental to the care and management of individuals with HIV. There is the potential for some neighborhood resources to serve as methods of complementary care, such as selling condoms in more businesses and support their sale in open space rather than behind the counter, as well as addressing the zoning laws related to alcohol selling establishments. We had hypothesized that being engaged in care would provide some level of protection from overall adverse neighborhood conditions, yet that was not supported. Neighborhood characteristics contribute to disparities in HIV management. To achieve the National HIV/AIDS Strategy of eliminating health disparities in HIV infections and care, interventions need to incorporate how communities may influence health behaviors.