Online Program

Neighborhood crime and sexual behavior among Black men living with HIV in Los Angeles, CA

Sunday, November 1, 2015

Bisola O. Ojikutu, MD MPH, Division of Global Health Equity, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
Laura M. Bogart, PhD, Boston Children's Hospital/Harvard Medical School, Boston, MA
David J. Klein, MS, Children's Hospital Boston, Boston, MA
Frank H. Galvin, PhD, Bienestar Human Services, Inc, Los Angeles, CA
Glenn J. Wagner, PhD, RAND Corporation, Santa Monica, CA
Background:  Black men are disproportionately impacted by HIV and are more likely to live in crime-ridden neighborhoods. Exposure to crime predisposes residents to depression and drug use, which are associated with increased sexual risk. Efforts to prevent sexual HIV transmission have focused on individual predictors and not on the environmental context. Here, we examined the association of neighborhood crime, independent of individual-level characteristics, with sexual behavior among Black men living with HIV.

Methods:  HIV-positive Black men on antiretroviral therapy in Los Angeles, California completed an audio computer-assisted self-interview measuring demographics and behavior. Participant addresses were geocoded. Crime risk per census block group was obtained from the National Uniform Crime Report. Multivariate logistic regression was used to generate adjusted estimates of associations between neighborhood crime and sexual behavior.

Results:  Among 193 men, 36% reported having multiple partners during the last 3 months [among sexually active, mean (SD)=2.7 (3.3) sexual partners], 36% reported condomless sex, and 43% reported sex with an HIV-negative or unknown status partner. In univariate analysis, crime (violent and non-violent) (p=0.003), depression (p=0.05), and drug use (p=0.002) were significantly associated with multiple sexual partners in the past 3 months. Crime [AOR=1.49, 95%CI (1.13–1.97)] and drug use [AOR=3.13, 95%CI (1.52-6.47)] remained significant in multivariate analysis. No significant associations emerged between crime and condomless sex or sex with an HIV-negative/unknown partner.

Conclusion:  Among Black men living with HIV, neighborhood crime is associated with having multiple sexual partners. Interventions to reduce transmission risk should incorporate structural components to reduce potential crime exposure.

Learning Areas:

Diversity and culture
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the relationship between neighborhood-level crime and sexual HIV transmission risk behavior in Black men living with HIV

Keyword(s): HIV/AIDS, HIV Risk Behavior

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an Assistant Professor of Medicine at Harvard Medical School based in the Division of Global Health Equity at Brigham and Women's Hospital. My research focuses on understanding structural factors impacting risk, clinical outcomes and sexual transmission of HIV.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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