“Geobehavioral vulnerability": An exploration of HIV/AIDS among Black Philadelphians

Issues: Disparate HIV/AIDS incidence and prevalence rates among racial and ethnic minorities, particularly in Black populations, are unacceptable health inequities that call for a move beyond the individual level. Accordingly, concentrated disadvantage, the hyper-incarceration of Black men, and geographically and socially constrained sexual networks more readily explain excessive disease burden. These factors cluster HIV in certain sexual networks, thus creating a “geobehavioral vulnerability” to HIV/AIDS—it is not just what you do, but also where you do it and with whom. Description: The purpose of this study was to explore individual, social and structural drivers of HIV/AIDS among black Philadelphians. To effectively accomplish the study aims, the project had three phases: 1) team-building, training project staff and elicitation research, 2) secondary data analyses and ethnography with multi-level modeling and GIS mapping, and 3) data integration and member checking. Lessons Learned: Preliminary analyses confirm that individual- (i.e., gender socialization), social- (i.e., constrained sexual networks) and structural-level factors (i.e., concentrated disadvantage) interact to influence not only individual behaviors, but also community-level indicators of HIV/AIDS burden (i.e. HIV incidence and prevalence rates) among Black Philadelphians. The concept of “geobehavioral vulnerability” was empirically supported. Recommendations: Knowledge of multi-level drivers of the HIV/AIDS epidemic can be used preemptively both to decrease transmission in highly affected/high prevalence areas and to prevent the spread of HIV to unaffected/low prevalence areas. These data can serve as the basis for designing multi-level community-based interventions to decrease the burden of HIV/AIDS in disenfranchised neighborhoods or larger geosocial settings.