How does neighborhood impact engagement in HIV-related risk behaviors?

HIV infection has become a manageable chronic disease due to treatment advances. Secondary prevention efforts have proven inadequate to reduce the estimated incidence of new HIV infections. Epidemiologic data suggests that geographic clustering of new HIV infections is a common phenomenon, particularly in urban areas among populations of low socioeconomic status. This study aims to assess the relationship between neighborhood conditions and HIV management and engagement in high-risk behaviors. During routine outpatient HIV clinic visits, 762 individuals from the St. Louis metropolitan area completed behavioral and psychological assessments. Biomedical markers were abstracted from their medical records. Census level factors were used with ArcGIS to analyze relationships between health behaviors and outcomes by neighborhood variables. The majority of the sample was male and African American. In the adjusted models, individuals residing in neighborhoods with higher poverty rate were more likely to have lower CD4 cell counts and more likely to be current smoker. In neighborhoods with higher rates of unemployment, individuals were less likely to have a current antiretroviral prescription. In more racially segregated neighborhoods, individuals reported more depressive symptoms. Additional analyses will include the relationship of neighborhood resources (alcohol- and condom-selling establishments, clinic distances) understanding that impact health outcomes Despite the advances in HIV disease management, disparities among HIV care continue to adversely affect efforts to prevent disease progression and transmission. Interventions that address neighborhood conditions as barriers to HIV management may provide improved health outcomes.