Where you live matters: Protective structural correlates of HIV risk behavior among young men who have sex with men in Metro Detroit

Background: Neighborhood characteristics are linked to HIV/STI risks, yet few have examined how neighborhood characteristics influence the HIV/STI risk of young men who have sex with men (YMSM).  

Methods: Using data from a cross-sectional survey of YMSM (ages 18-29) living in Detroit Metro (N=345; 10% HIV-positive; 49% Black, 26.7% White, 15.1% Latino, 9.3% Other race), we used multilevel modeling to examine the association between community-level characteristics (e.g., density of African American households in neighborhood; distance to LGBT-affirming institutions) and YMSM’s HIV testing behavior and number of partners with whom they had unprotected anal intercourse. In our neighborhood-level analyses, we accounted for individual-level factors (race/ethnicity, poverty, homelessness, residential instability, and HIV/STI diagnoses).

Results: Our multilevel models indicated that YMSM living in more densely populated African American neighborhoods were more likely to have ever tested for HIV and to engage in receptive (URAI) and insertive (UIAI) unprotected anal intercourse, respectively. Greater distance to AIDS Service Organizations was associated with lower odds of HIV testing and greater URAI partners. Distance to LGBT bars was associated to HIV testing, whereas distance to LGBT organizations was related to UIAI partners. After accounting for neighborhood effects, YMSM with a history of prior STIs and who reported recent residential instability were more likely to report engaging in HIV risk behaviors.

Conclusions: We discuss the implications of our findings for HIV/STI prevention, including the notion that efforts to counteract structural barriers in Detroit Metro may aid to address the HIV/STI disparities faced by YMSM.