Individual risky behaviors (ex. condomless sex, multiple partners, drug use) have long been a focus of HIV research and intervention strategies for sexual minority men (SMM). However, focusing on the individual level obscures the effects of broader societal influences and disparities. Importantly, Black SMM experience higher rates of HIV infection than their white counterparts, despite engaging in similar or fewer HIV risk behaviors. Individual behaviors cannot explain this disparity, and behavior-focused interventions cannot close this gap.
It is important to consider the upstream, structural causes of health disparities, especially those that are modifiable, in order to inform justice-oriented interventions. One such upstream cause is neighborhood factors.
Neighborhood problems — such as excessive noise, speeding cars, trash and litter, and lack of access to adequate food, shopping, sidewalks, parks and playgrounds — can have an impact on residents’ health. There are three major ways that these neighborhood problems operate on health. First, these problems can be stressors that prompt residents to engage in unhealthy behaviors as coping mechanisms (ex. Illicit drug use). Second, neighborhoods that are less pleasant to spend time in and more difficult to navigate can lack the social cohesion and community that can be protective when it comes to health behaviors. And third, neighborhood problems are often indicative of general disinvestment. The accompanying lack of access to material resources and services that might help residents avoid unhealthy behaviors and promote health preservation.
Dr. Dustin Duncan and colleagues at Columbia’s Spatial Epidemiology Lab conducted a study of 377 Black SMM in Jackson, Mississippi and Atlanta, Georgia to look for connections between neighborhood problems and HIV. Their findings suggest that “structural interventions that improve community infrastructure to reduce neighborhood problems (e.g., trash and litter) could help to alleviate the incidence of HIV among Black MSM in the Deep South.”
The study’s main finding was that a higher number of neighborhood problems was associated with drug use before or during sex. As a result, neighborhood problems could be considered a risk factor for HIV transmission.
We know that neighborhood problems are the by-product of historical neglect, especially of racially and economically segregated areas. Improving the infrastructure of these underserved neighborhoods could be one step in alleviating the incidence of HIV among Black SMM in the Deep South.
Reference: Duncan DT, Sutton MY, Park SH, Callander D, Kim B, Jeffries WL 4th, Henny KD, Harry-Hernández S, Barber S, Hickson DA. Associations Between Neighborhood Problems and Sexual Behaviors Among Black Men Who Have Sex with Men in the Deep South: The MARI Study. Arch Sex Behav. 2020 Jan;49(1):185-193.