Using GIS to assess structural barriers to HIV Services in Boston, MA

Background: Structural barriers to health services, such as inadequate public transportation, have significantly been associated with poorer health outcomes, especially among vulnerable populations such as persons living with HIV/AIDS. Methods: The addresses of 27 federally funded HIV service providers (medical and non-medical) in Boston, MA representing 5 main service categories were geocoded using ArcGIS. The service categories offered at each site were featured using stacked symbols, since one site might offer multiple services.  To examine whether these services were equally distributed in areas most affected by HIV, the geocoded sites were plotted over HIV prevalence for each neighborhood in Boston (n=16). To examine whether these services were accessible by public transportation, the geocoded sites were also plotted over major public transportation routes. Half-mile buffers were then created around each site to assess walkability to and from public transportation. Results: The South End (3,649 HIV cases/100,000 population), Roxbury (1,431 cases/100,000 population) and Jamaica Plain (1,000 cases/100,000 population) had the highest rates of HIV, with 8 service providers representing 4 of the 5 major service categories within these neighborhoods. All sites were within walking distance (i.e., ≤0.5 miles) to major public transportation lines. The buffer analysis also identified 3 “service areas,” with some service areas having sites that are closer together than others. Conclusion: Most HIV service types are available in neighborhoods most affected by HIV in Boston and are accessible by public transportation. However, further research is needed to determine and address structural barriers that may exist within these service areas.