HIV Battle Must Focus On Hard-Hit Streets
When it comes to HIV, geography can be destiny, argue authors of a new article in the American Journal of Public Health. The epidemic has become heavily concentrated in poor urban neighborhoods where people are less likely to be tested and treated, creating more risk that the virus will spread. New prevention efforts should focus on neighborhoods.
In U.S. cities, it’s not just what you do, but also your address that can determine whether you will get HIV and whether you will survive. A new paper in the American Journal of Public Health illustrates the effects of that geographic disparity – which tracks closely with race and poverty – and calls for an increase in geographically targeted prevention and treatment efforts.
“People of color are disproportionately impacted, and their risk of infection is a function not just of behavior but of where they live and the testing and treatment resources in their communities,” said lead author Amy Nunn, assistant professor (research) of behavioral and social sciences in the Brown University School of Public Health. “Limited health services mean more people who don’t know their HIV status and who are not on treatment. People who don’t have access to treatment are much more likely to infect others. Simply having more people in your sexual network with uncontrolled HIV infection raises the probability that you will come into contact with the virus. This is not just about behavior, this is about access to critical health services.”
It’s no secret that the United States has economic disparities in access to health care, but the consequences of that for the HIV epidemic are laid bare in maps in the paper. They show that the nation’s epidemic has become concentrated in urban minority neighborhoods, where HIV incidence can be comparable to some countries of sub-Saharan Africa.
The high-incidence minority neighborhoods of New York and Philadelphia, the maps show, have a high death rate as well, even compared to simlarly high-incidence neighborhoods that are wealthier and whiter. The most likely difference between the communities, Nunn said, is in their access to testing, treatment, and care services.
Nunn and co-authors including Phill Wilson, president and CEO of the Black AIDS Institute, said federal and state public health efforts should recognize that geography contributes to HIV risk and focus greater efforts on targeting the most heavily impacted neighborhoods around the country. Instead, there has been less federal money for interventions outside of clinical settings.
“With the new surveillance tools available to us, we know where the epidemic is down to the census track or zip code,” Wilson said. “If we are serious about ending the AIDS epidemic in this country, we need to use those tools to invest in vulnerable communities. Unfortunately, instead of building infrastructure and expanding capacity in poor urban communities, we are dismantling the fragile infrastructure that exists.”
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