Healthography and Black Heterosexual Men's Sexual HIV Risk: The Role of Neighborhood Context

Background: Individuals, rather than social-structural factors, have been the primary focus of most HIV prevention research.  Consequently, considerable gaps exist about how social-structural factors such as neighborhoods facilitate or hinder sexual HIV risk.  This is particularly the case for Black heterosexual men who do not inject drugs or report heavy drug use.  Evidence of a generalized HIV epidemic (>1%) among Black heterosexuals in impoverished urban U.S. communities, underscore the need for more research on neighborhood context and sexual HIV risk for Black heterosexual men.

Method: We used structural equation modeling (Mplus 7.11) to test a model of the pathways between neighborhood context (neighborhood disorder, personal and neighborhood violence), depression, substance use, and Black sexual risk behavior. Participants were 526 self-identified Black heterosexual men, ages 18 to 45 recruited in Philadelphia, PA via randomized venue-based probability sampling (e.g., restaurants, corner stores).

Results: With the exception of the hypothesized pathway between depression and substance use, all hypothesized direct pathways were significant. We observed significant positive direct effects from neighborhood context, depression, and substance use on sexual risk.  Results suggest that variability in sexual risk is explained by direct influences of neighborhood context, depression, and substance use, with the latter also being a conduit through which additional neighborhood context effects exert influence.

Conclusion: In the context of Black heterosexual men’s sexual HIV risk, healthography matters.  Our study underscores the need for more research and interventions to address and reduce the effects of negative neighborhood context on Black heterosexual men’s sexual HIV risk behaviors.