Neighborhood-Level Structural Factors, HIV, and Communities of Color

Abstract

Neighborhoods and health studies have focused on a wide range of health outcomes, including HIV outcomes such as condomless sex and HIV acquisition. This growing body of research connecting neighborhoods to sexual behaviors [e.g., condomless anal intercourse], HIV prevention behaviors [e.g., pre-exposure prophylaxis (PrEP) use], and HIV care behaviors [e.g., antiretroviral therapy (ART) use] has been conducted in different populations across geographic regions. In this chapter, we overview studies focused on neighborhood factors and HIV outcomes, with special attention to relevant research focused on communities of color in the United States. In particular, we discuss how various social (e.g., racial segregation, neighborhood disadvantage, neighborhood disorder) and built (e.g., public transit, availability of sexually transmitted infections [STI] testing locations) environmental characteristics relate to a wide range of HIV outcomes. Various neighborhood characteristics have been related to HIV health outcomes in communities of color, including high-risk groups such as Black gay and bisexual men. Like the vast majority of neighborhoods and health research, neighborhoods research focused on HIV is largely cross-sectional and there is a clear paucity of evidence of neighborhood-level HIV-related interventions. However, the findings from observational studies suggest that neighborhood-level interventions can improve sexual health and related HIV outcomes and therefore should be explored.