Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men

Abstract

In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.

Social-Environmental Resilience, PrEP Uptake, and Viral Suppression among Young Black Men Who Have Sex with Men and Young Black Transgender Women: the Neighborhoods and Networks (N2) Study in Chicago

“…Theoretical and empirical work suggests that such high HIV prevalence among these vulnerable populations is not driven by factors at individual level, as black MSM, for example, are often no more likely to engage in behaviors that increase risk of HIV infection (e.g., using drugs during sex, condomless anal intercourse) [3,4]. Rather, the racial disparity in HIV incidence is produced and perpetuated by more distal factors, including the characteristics of networks and neighborhood environments [3][4][5][6].…”

The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain)

“…Individual-level adverse health outcomes may be influenced directly or indirectly by the environment where a person lives [8][9][10]. Gay neighborhoods have been associated with HIV infection [11,12], although there is some debate over whether living in a gay neighborhood is a risk factor or protective factor.…”

“…Gay neighborhoods have been associated with HIV infection [11,12], although there is some debate over whether living in a gay neighborhood is a risk factor or protective factor. Tieu et al [9] associated living in a gay neighborhood with safer sex behaviors such as more frequent condom use for receptive and insertive anal sex. This agrees with the fact that individuals who perceive a higher sense of community and neighborhood participation are more likely to report fewer risk behaviors [9].…”

“…Tieu et al [9] associated living in a gay neighborhood with safer sex behaviors such as more frequent condom use for receptive and insertive anal sex. This agrees with the fact that individuals who perceive a higher sense of community and neighborhood participation are more likely to report fewer risk behaviors [9]. In contrast, living in a gay neighborhood has been associated with the use of drugs to enhance sexual experiences [11,13].…”

Awakening to an Intersectional Reality: Ending the HIV Epidemic in the USA Starts with Reducing Inequities among Black MSM

“…This special issue opens with three articles that focus on understanding how social/structural forces operating in local ecological contexts influence HIV. Tieu et al [5] offer potential pathways by which neighborhood-and network-level factors affect the HIV care continuum for Black MSM while Cassels et al [6] identified place-related patterns that influenced HIV vulnerability and access to health care among substance-using Black MSM in Los Angeles. Hotton et al [7] investigated neighborhood-level and socio-structural predictors of criminal justice involvement among MSM in Chicago, which is a particularly salient topic given how the over-policing and criminalization of Black communities hasled to large proportions of Black men being exposed to the criminal justice system.…”