Association of Adverse Neighborhood Exposures With HIV Viral Load in Pregnant Women at Delivery

Abstract

IMPORTANCE Racial disparities in maternal morbidity and mortality are in large part driven by poor control of chronic diseases. The association between adverse neighborhood exposures and HIV virologic control has not been well described for women with HIV during pregnancy. OBJECTIVE To evaluate the association between adverse neighborhood exposures and HIV viral load at delivery.

Neighborhood characteristics and HIV treatment outcomes: A scoping review

“…This construct focuses on the range of economic and social resources of a neighborhood’s residents. Among the 23 studies that discussed neighborhood level SES, two studies discussed its outcomes on ART initiation [ 67 , 79 ], two studies discussed ART adherence [ 81 , 86 ], 15 studies discussed HIV viral suppression[ 70 , 72 , 77 , 78 , 80 – 82 , 88 , 91 , 93 – 95 , 99 , 100 ], and 6 studies combined neighborhood SES factors into a composite measure, making it difficult to assess the impact of each factor individually [ 68 , 74 , 75 , 85 , 87 , 101 ].…”

“…Out of the fifteen studies assessing HIV viral suppression, seven found no association with neighborhood level income [ 70 , 72 , 78 ], affluence [ 80 ], residential stability [ 80 , 81 ], health care access [ 70 , 80 ], and food accessibility [ 88 , 99 ]. Six studies found inverse associations with HIV viral suppression and neighborhood level income [ 95 ], education [ 81 , 82 , 100 ], lack of car ownership [ 77 , 81 , 100 ], residential instability [ 91 ], percent of female-headed households [ 81 ], and food inaccessibility [ 80 ]. A positive association with HIV viral suppression was observed among men who have sex with men (MSM) living in areas that were more concentrated with MSM-headed households [ 70 ], neighborhoods with low poverty, low unemployment, high insurance coverage, and high education attainment [ 93 ].…”

“…Nine studies combined poverty indicators with other characteristics to create a composite measure, making it difficult to assess the impact of living below the poverty line alone [ 70 , 72 , 74 , 75 , 78 , 80 , 85 , 88 , 101 ]. Six studies found no association between the percentage of households or residents living below the poverty line and ART initiation [ 67 , 96 ] or HIV viral suppression [ 82 , 84 , 89 , 96 , 99 ]. However, 12 studies found an association between the percentage of households or residents living below the poverty line and ART initiation [ 79 , 83 ], ART adherence [ 90 , 98 ] and HIV viral suppression [ 69 , 73 , 77 , 81 , 83 , 87 , 91 , 100 ].…”

“…This construct focuses on residents’ differential experiences and feelings of belonging. Among the 18 studies that assessed the composition and interaction in neighborhoods, four assessed its effect on ART initiation [ 67 , 71 , 79 , 96 ], none on ART adherence, 13 on HIV viral suppression [ 69 – 72 , 74 , 78 , 80 , 82 , 88 , 89 , 92 , 96 , 99 ], and three studies combined composition and interaction factors into a composite measure, making it difficult to examine the impact of each characteristic individually [ 68 , 75 , 87 ]. Three of the four studies on the associations with ART initiation found no association with Aboriginal residential density, [ 67 ] African American residential density [ 96 ], social cohesion, or social support [ 71 ].…”

Maternal childhood trauma and prenatal stressors are associated with child behavioral health

“…A growing body of epidemiological and health research indicates that broader neighborhood factorssuch as objective measures of poverty or residential stabilityare associated with physical and mental health problems. [13][14][15] Fewer studies have looked at the associations between stress related to neighborhood crimesuch as violent crime rates as reported by law enforcement agenciesand increased health problems, however growing research suggests a positive association between living in neighborhoods with higher crime and experiencing more mental health problems, including stress, anxiety, and depression. [16][17][18][19] Fewer still have examined this association intergenerationally to assess whether these risks are transmitted to offspring in a manner that impacts their wellbeing, 7 and to our knowledge none have looked beyond birth outcomes.…”