Neighborhood Socioeconomic Disadvantage and Former Jail Inmates’ HIV Testing Behavior

Introduction: A small body of literature examines how structural factors influence HIV risk behaviors, but fewer studies have explored the role that neighborhood plays on health protective behaviors related to HIV. Comprehensive HIV prevention strategies rely on more than reducing risky behaviors; engaging in protective behaviors (e.g., condom use, HIV testing) is also a key component. Rates of HIV are 2 - 5 times higher among criminal justice system involved people than the general population, and most infections occur in the community. After release, former inmates must navigate many decisions that can affect their health. Understanding how the neighborhoods to they return affect their health decisions may reveal strategies to promote health equity for this underserved group. As such, the present study aimed to investigate the relationship between neighborhood disadvantage and HIV testing among former jail inmates during their first year post-release.

Methods: Using cross-sectional data from a longitudinal study of former jail inmates in the DC metropolitan area (n= 247), the present analyses examined whether HIV testing during the first year post-release was associated with neighborhood-level socioeconomic disadvantage and individual-level factors (e.g., race, individual socioeconomic status variables, sexual behaviors). To examine the stability of these findings, four different calculation techniques for assessing neighborhood-level socioeconomic disadvantage were examined.

Results: Nearly 62% of participants reported that they received an HIV test during their first year post-release. In separate regression analyses, three out of four neighborhood-level socioeconomic disadvantage measures showed that living in disadvantaged neighborhoods was associated with more frequent HIV testing (R² = .02 - .03, p’s <.05), while one found no significant relationship. The effect of neighborhood-level socioeconomic disadvantage on HIV testing was attenuated to non-significance once specific individual-level characteristics (e.g., race, multiple sexual partnerships, number of HIV-positive people known), which may represent facets of HIV salience, were included in the models.

Conclusions: This set of findings has implications for public health programs aimed at increasing HIV testing rates, especially among populations at increased risk for HIV such as former inmates. Prevention efforts targeting multiple levels of influence (e.g., neighborhood, individual) may help to increase HIV testing rates. While programming should continue to target communities hit the hardest by HIV, which are disproportionately disadvantaged communities, interventions should also seek to increase the salience and importance of HIV testing for individuals residing across the socioeconomic spectrum.