Table 4.
Study results and future directions
| Article citation | Sample description | Key findings/conclusions | Future directions |
|---|---|---|---|
| Akers, A. Y., Muhammad, M. R., & Corbie-Smith, G. (2011) | 42 participants in general adult group, 13 formerly incarcerated, and 38 adolescents and young adults; larger proportion of women in general adult and adolescent/young adult groups; general adult population had higher educational attainment than formerly incarcerated adults; formerly incarcerated adults on average under than general adults most participants made less than $40,000 for an annual income | Absence of recreational options & limited safe environments for socializing for community, adolescent focused themes: lack of diverse leisure-time activities, few recreational options for dating, access to inappropriate leisure activities promoting risk behaviors, cost-barriers to recreational activities, inadequate parental supervision of time alone and with opposite-sex friends, and poor community monitoring of social activities; developed conceptual model linking neighborhood social and structural organization that may contribute to adolescent sexual behaviors | Focus group findings contributed to the development of a conceptual framework and findings of this study can inform future interventions that are specific to the neighborhood and community context |
| Bauermeister J.A., Eaton L., Andrzejewski J., Loveluck J., VanHemert W., Pingel, E.S. (2015) | Sample predominately Black, gay-identified, Above federal poverty level, and not in a relationship | HIV testing associated with greater socioeconomic neighborhood disadvantage, being black, being in a relationship, and community acceptance. Participants less likely to test reporting individual poverty and longer distance to ASO. UAI with serodiscordant partner associated alcohol use, poverty, distance and from ASO. Protective factors for UAI: neighborhood socioeconomic disadvantage and being in a relationship | Examine whether HIV-related correlates vary based on whether YMSMS live in closer proximity to areas with greater concentrations of ASOs and venues servicing LGBT clientele |
| Bauermeister, J. A., Zimmerman, M. A., & Caldwell, C. H. (2011) | Average age about 15 years old; less than half (42.6%) live with mother or mother and siblings; 14.51% reported households that were receiving public assistance and 21.42% of households were earning less than $15,000; 8.98% of participants lived in a household without a high school degree | No direct association between initial condom use scores and proportions of households with less than a high school degree or with varying unemployment rates; no indirect relationship between neighborhood disadvantage and condom use over time; neighborhood disadvantage associated with more consistent condom use | Future studies will be conducted to explore how positive and negative neighborhood characteristics influence youths' sexual behaviors in order to develop community-level HIV/STI prevention programs |
| Biello, K. B., Niccolai, L., Kershaw, T. S., Lin, H., & Ickovics, J. (2013) | Participants ages ranged from 14–27, with the greatest proportion of participants aged 17–21 years old. A total of 1388 participants lived in hypersegregated areas, with 647 of these individuals identifying as Black non-Hispanic and 741 identifying as White, non-Hispanic. 3195 participants resided in non-hypersegregrated areas, and 1183 of these individuals identified as Black, non-Hispanic while 2012 identified as White, non-Hispanic | Sexual risk behavior scores increased as participants aged into adolescense, scores leveled off and decreased by mid 20s; African Americans initially at higher risk than Caucasians; Caucasian risk increased over time to surpass African American sexual risk scores; hypersegregation was not associated with increased sexual risk scores nor did it modify the trajectory of sexual risk scores over time | Future research should explore whether segregation is associated with sexual networks and if networks mediate the relationship between segregation and STIs; future studies will examine whether concurrency and sex with casual and high-risk partners is associated with segregation |
| Bluthenthal, R. N., Do, D. P., Finch, B., Martinez, A., Edlin, B. R., & Kral, A. H. (2007) | Sample predominantly male (> 70%), minorities (> 60%), with low paying employment (15%), high experiences of homelessness (50%), and moderate HIV prevalence (11%) | Unadjusted models indicate that there is a statistically significant relationship between community economic and racial factors and receptive and distributive syringe sharing outcomes, but do not account for differences across tracts; adjusted models demonstrated that percent African American had an effect on syringe sharing (less syringe sharing) and unprotected sex (lower odds of unprotected sex) | Research investigating proximal measures of HIV risk behaviors, such as the presence of prostitutes, shooting galleries, crack houses, drug markets, and incidence of drug users, can provide meaningful information to understanding community context; further research is needed to determine risk and protective factors for HIV at the community level |
| Bobashev, G. V., Zule, W. A., Osilla, K. C., Kline, T. L., & Wechsberg, W. M. (2009) | Majority of sample identified as male in both syringe sharing (71.1%) and sexual behavior (69.5) sample groups; mean age was around 43 years old; majority of sample either identified as African American or White for both groups; about half of participants in either group reported homelessness and about 15% of syringe sharing and 16% of sexual behavior samples reported that paid work was their main source of income | Homelessness, history of injection, bisexual behavior, forced first sexual encounter, and perceived neighborhood violence associated with increased odds of males selling sex; homelessness, history of incarceration, history of injection, elevated substance use, bisexual behavior, forced first sexual encounter, elevated psychological distress, and elevated perceived neighborhood disorder and perceived neighborhood violence associated with males purchasing sex | Respondent driven recruitment can be an effective strategy for recruiting drug users and MSM in rural and urban settings; further research is needed to understand the relationship between bisexual behavior and transactional sex to see if transactional sex promotes the spread of HIV and STIs to other groups in the general population |
| Bowleg, L., Neilands, T. B., Tabb, L. P., Burkholder, G. J., Malebranche, D. J., & Tschann, J. M. (2014) | Age: M = 28.8, SD = 7.75; 63% of participants reported as having high school education, a GED or less; almost half (48%) made < $10,000 and majority (64%) unemployed | Results suggest that variability in sexual risk is explained by direct influences of neighborhood context, depression, and substance use, with neighborhood context influencing sexual risk behaviors through substance abuse indirectly | Future interventions to reduce sexual risk require consideration of social-structural level variables that influence sexual risk behaviors |
| Boyer, C. B., Greenberg, L., Chutuape, K., Walker, B., Monte, D., Kirk, J.,... & Adolescent Med Trials, N. (2017) | The median age of participants was 21.0 years; 42.2% were males, and 4.6% were transgender (most reported a birth sex of male). Almost one-third (32.1%) identified as gay or lesbian and 18.1% identified as bisexual. The majority (66.2%) of participants identified as Black, non-Hispanic and 21.0% identified as Hispanic. A small number (1.3%) of participants were ‘living on the street’. One-third (29.5%) had experienced homelessness. Roughly 16.% of participants reported exchanged sex, 13% had sex with someone they knew to be HIV-infected, 8% had sex with someone who injected drugs, and 1.3% also injected drugs. One-third of participants (32.1%) reported a history of having an STI, and 83% tested for HIV previously | Multivariate comparisons identified a variety of characteristics-being male or transgender, homelessness, sex with a partner who has HIV, STI history, unemployment, reduced job training access, housing instability, crime victimization, perceived community norms of exchanged sex- as significantly associated with increased exchange of sex (p < 0.05) | More research targeting adolescents and young adults to address initiation of transactional sex, conditions in which it occurs, and frequency and length of warranted exchange sex. Longitudinal studies on predictors of transactional sex |
| Braine, N., Acker, C., Goldblatt, C., Yi, H., Friedman, S., & DesJarlais, D. C. (2008) | Black participants (n = 101) statistically significantly (p < 0.001) older (average age = 40.6), less likely to have completed high school (53%), have ever been incarcerated (87%) as compared to their white counterparts (n = 50) in this study (average age = 32.0, high school graduates = 94%, ever incarcerated = 44%) | Hill District contains significant and visible drug market activity for both white and black participants; neighborhood of residence reflects historical patterns of racial segregation of Pittsburgh; strong pattern within social networks of syringes flowing from blacks to whites (93% of black-white dyads and 70% of white-black dyads involve whites receiving syringes from blacks) | This study illustrated that IDUs maintain long-term social networks across neighborhoods within urban settings and can use them to reduce the risk of HIV transmission |
| Brawner B.M., Reason J.L., Hanlon K., Guthrie B., Schensul J.J. (2017) | Participants included three administrators, three direct HIV/AIDS service providers and four community members. All participants were African American; nine women and one man. Mean age: 31.3 years. All participants had a high school diploma or general educational development (GED) certificate; 3 completed postgraduate work. 90% of participants employed. Four participants had annual household income less than $40,000. 3 received public assistance | Geographic and social constraints can increase HIV risk by constraining selection pool of potential partners to locales with elevated HIV burden. Black neighborhoods have abundance of bars, liquor stores and welfare offices, but lack relevant resources such as health centers. There are a lack of resources to combat HIV in the areas that need them the most. Racial segregation concentrates Black people into areas with elevated HIV burden | Community-level HIV prevention approaches have potential to reduce multilevel influences of the HIV epidemic and these approaches should involve stakeholders in the process |
| Brawner, B. M., Guthrie, B., Stevens, R., Taylor, L., Eberhart, M., & Schensul, J. J. (2017) | Compared to predominately white tracts, predominantly black tracts had lower percentages of residents with GEDs, higher unemployment, and higher percentages of persons living below federal poverty level. Among HIV/AIDS cases (N = 319), male-to-male sexual transmission was predominant mode of transmission (59.9%). 14.7% of cases attributable to IDU. Cases predominately male (80.3%), black (47.3%), and mean age of 48.1. Most recently mean CD4 count was 117 (SD = 133) | Lower odds hetero transmission (vs. IDU) for Census tracts with high HIV prevalence among Blacks compared to tracts with high HIV prevalence of Whites (OR: 0.25) Females more likely for hetero vs IDU (OR: 5.3). Compared to privately insured/HMO, Medicaid and uninsured less likely for MTM vs IDU (OR 0.04 and OR 0.07), respectively). Blacks more likely (OR 7.43) for hetero vs MTM. Medicaid more likely for hetero vs MTM transmission (OR 9.69) than privately insured/HMO. Odds of IDU vs MTM transmission higher among Medicaid (OR 22.85) and uninsured (OR 14.40), respectively | Findings can be used to guide larger studies for the development of future neighborhood-level structural interventions. Develop risk-reduction programming considering the ways in which neighborhood characteristics may be influenced by dominant risk behaviors (e.g., opening a needle exchange program in an area with high IDU prevalence) |
| Buot, M. L. G., Docena, J. P., Ratemo, B. K., Bittner, M. J., Burlew, J. T., Nuritdinov, A. R., & Robbins, J. R. (2014) | N/A | Income inequality, poverty, and racial segregation were significant predictors of HIV incidence in 2000; High income inequality, low incomes, high unemployment, high poverty, low home ownership, and high cost of living correlated positively with HIV incidence, risk increased by 2–threefold; low rates of marriage within cities demonstrated roughly fourfold higher HIV rates; Rates by heterosexual contact were significantly associated with income inequality, poverty, education, and segregation; MSM risk is associated with income inequality, poverty and segregation (at lower values) | Future intervention efforts should view the continuation of the HIV epidemic as a set of recurring structural circumstances that select for viral transmission |
| Buttram, M. E., & Kurtz, S. P. (2013) | Residents in the gay neighborhood (Wilton Manors) tended to be older, white, and slightly more educated than other areas of Miami/Ft- Lauderdale | Methamphetamine use, increased reported receptive UAI, and decreased reported prosocial participation were found to be associated with gay neighborhood residence; gay neighborhood residence appeared to be protective against cocaine use and substance dependence | Future research should examine how men decide to move to a gay neighborhood versus other locations, and how they experience living in different types of neighborhoods, which can inform how risk and protective factors associated with varying neighborhood contexts |
| Cené, C. W., Akers, A. Y., Lloyd, S. W., Albritton, T., Powell Hammond, W., & Corbie-Smith, G. (2011) | 4 samples: focus groups—individuals age 16–24, individuals age 25 and older, the formerly incarcerated. Interviews: participants deemed by community partners as knowledgeable about HIV risk and prevention | Four themes emerged impacting HIV vulnerability: Interpersonal processes (social cohesion, social tension, and HIV-related stigma), community structural factors (availability of resources, accessibility of resources, segregation, political forces, & institutional racism) social disorder, and civic engagement. Stigma, lack of community resources (for example funding to address HIV), and lack of care access led to risk behaviors (as escapism), resources to adequately address HIV at the structural level and inhibited HIV prevention (like testing) | Clinicians should consider assessing social histories of patients to tailor treatment recommendations |
| Cooper, H. L., Friedman, S. R., Tempalski, B., & Friedman, R. (2007) | Of MSAs, 79% had residents that identified as White, Non-Hispanic; MSAs fairly evenly distributed across geographic regions (Northeast, South, Midwest, and West) of the US. The median adult population was 720,975 per MSA | Median injection drug use prevalence was 1983 per 100,000 Black adults (interquartile range: 1422 to 2759 per 100,000). Median isolation index was 0.48 (range: 0.05 to 0.84). Average Black resident in this study resided a Census tract where 48% or greater were also Black. An increase of 0.50 in racial isolation was associated with a 23% increase in injection drug use prevalence among Black adults. Racial concentration was unrelated to injection drug use prevalence among Black adults | Future studies should examine the pathways through which increased racial isolation is associated with injection drug use prevalence; examination of other racial/ethnic groups should be conducted as well; future research should also explore the extent to which racial isolation influences the distribution if injection drug use and related health problems among urban Black populations |
| Cooper, H. L., Linton, S., Haley, D. F., Kelley, M. E., Dauria, E. F., Karnes, C. C., … & Adimora, A. (2015) | Participants were mostly women with a mean age of 43 years old; high poverty (mean annual income $9849) at baseline | Mean poverty rate in tracts in which public housing complexes occurred (46%) was higher than the mean poverty rate in tracts that participants moved to (30.2%). Perceived partner declined after individuals relocated from housing complexes; decreased perceived partner risk was associated with reduced violent crime rates and reduced perceived community violence | Future research must contribute to efforts to diminish place-based inequalities to eliminate disparities |
| Cooper, H. L., Linton, S., Kelley, M. E., Ross, Z., Wolfe, M. E., Chen, Y. T., … & Semaan, S. (2016) | The sample lived in 15 states, 19 MSAs, 51 counties, and 969 zip codes. About half (51.79%) of the participants were black 30.24% were white, and 17.97% were Latino. About a quarter (28.40%) of this sample was female and the average age was 45.76 (SD = 10.55). Most participants were impoverished and 39.80% were currently homeless. Participants had injected drugs for an average of 23.27 years (SD = 12.98); primarily injected heroin; and most injected more than once a day. HIV serostatus varied by race/ethnicity, with 10.70% of black PWID, 7.60% of Latino PWID, and 6.24% of white PWID testing positive. Participants were mostly women with a mean age of 43 years old; high poverty (mean annual income $9849) at baseline | Black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes; black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates; Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales);. Latino/ white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates) | Future research should assess the extent to which varying environmental exposures are associated with disparities in HIV-related outcomes among IDUs |
| Crawford, N. D., Borrell, L. N., Galea, S., Ford, C., Latkin, C., & Fuller, C. M. (2013) | Most participants were more likely to be black and Hispanic, male, lower socio-economic status and un-married. The majority of the sample did not inject drugs and used crack cocaine. The median number of female and male sex partners was 1 (IQR: 0–2) and 0 (IQR: 0–1), and most participants used condoms infrequently regardless of the partner’s gender. The median age at sexual debut was 14 (IQR: 12 – 16) and most participants received four or more HIV tests in their lifetime. Most experienced depression in their lifetime | Experiencing discrimination due to drug use associated with drug ties in neighborhoods with fewer blacks. Communities with lower educational attainment associated with greater drug using and heroin/injecting ties | Future research should examine how neighborhood context impacts relationships regarding discrimination and development of high risk-relationships and tailor interventions to address social discrimination |
| DePadilla, L., Elifson, K. W., & Sterk, C. E. (2012) | Sample was split equally based on gender (49% men and 51% women) and 51% were older than 35 years old | Age 35 or older, alcohol use, steady partnership, having never been homeless, and perceived neighborhood disorder were associated with increased odds of lack of condom use when engaging in vaginal sex in the past 30 days. Crack/cocaine use, marijuana use, increased social cohesion, consistent health insurance, and having more than one steady partner were negatively associated with a lack of condom use in the past 30 days | Social science research should recognize the importance of epidemiological information in the larger socio-political and ecological context in future studies |
| Duncan, D. T., Kapadia, F., & Halkitis, P. N. (2014) | Of the five New York City boroughs, 32% and 15% of participants reported residence in Manhattan or Brooklyn, while approximately 10% reported either The Bronx or Queens as their borough of residence | About two-thirds of participants reported concordance between residential/socializing, residential/sex, and sex/socializing boroughs, while 25% reported concordance between all three residential, socializing, and sex boroughs. Borough concordance varied by some individual-level characteristics. YMSM who reported experiencing gay-related stigma in public forums were more likely to report discordant socializing/sex and residential/socializing/sex boroughs (p < 0.001). YMSM who reported residential/socializing/sex borough concordance were more likely to report recent (last 30 days) alcohol use, recent marijuana use, and recently engaging in condomless oral sex (all p < 0.05) | Future research among YMSM populations should consider multiple neighborhood contexts in order to provide a more nuanced understanding of how and which neighborhood contexts influence the health and well-being of YMSM |
| Participants had high education, low income, and high levels of substance dependence, mental health problems, HIV infection and ongoing sex risk | Men who lived in South Florida for greater than one year had a statistically significant greater number of friends who use drugs (t = -2.82, p = .005) and greater proportion who were HIV positive (t = -2.43, p = .02); me who resided in South Florida for 1–5 years reported a statistically significantly greater number of unprotected anal intercourse in the past 90 days than those who resided in that area for less than one year (t = -2.69, p = .009) | Future interventions should focus on the immediate post-migration period and incorporate skills and needs for social relationships with the broader community | |
| Egan, J. E., Frye, V., Kurtz, S. P., Latkin, C., Chen, M., Tobin, K., … & Koblin, B. A. (2011) | Mean age was 34 years old; participants identified as Latino (30%), African American (30%), multiracial (20%), white (15%), or Asian American (5%); seven men were HIV positive | Both men who were born in NYC or migrated to it sought neighborhoods with reduced discrimination and more social opportunities; those who grew up outside of Manhattan but in NYC described anti-gay and homophobic attitudes in their original neighborhoods; the importance of community engagement within their residential neighborhood varied greatly among participants, with participants describing the positive (acceptance, reduced oppression) and negative (increased availability of sex and drugs, social pressures to conform to norms of appearance/conduct, lack of affordability of housing) aspects. Men who traveled between gay neighborhoods often modified their behavior based on their location (gay neighborhood vs other neighborhoods) and who they were with (gay friends vs others); some men felt excluded from the gay neighborhood (Chelsea) related to race/ethnicity stereotypes of who lives there (white, middle-class, stylish, fit men) | Research regarding the relations among behaviors and neighborhoods can contribute to geographically specific and norms-based health outreach and programs |
| Participants reported sociodemographic disadvantage with 79.68% having ever been incarcerated in life and only 27.7% working full or part time and only 46.3% have an income of more than $10,000 | more than half of participants reported sexual partners outside of their neighborhood and about 20% had a partner living in the same neighborhood but not the same household; the average number of sexual partners was about 3, with no statistically significant difference in the number of partners based on whether or not partners lived in the same household (p = 0.99); participants living with their sexual partners report statistically significant greater financial dependence on partners (p = 0.004) | Studies should explore the relationship between residential location of partners and co-habitation, with mental and physical health outcomes, such as HIV care and support for medication adherence | |
| Frew, P. M., Parker, K., Vo, L., Haley, D., O'Leary, A., Diallo, D. D., … & Hodder, S. (2016) | The median age of the women in our sample was 27 years. Most women in the sample were Black/African American (86%, n = 247) and reported having a “non-partnered” single status (67%, n = 194) | Perceived discrimination inhibits efforts to target African American communities for initiatives to address HIV risk reduction. An imbalance of available male sexual partners in communities also increases HIV vulnerability. Individuals from disadvantaged communities engage in survival sex to achieve basic needs | Programs emphasizing financial education and resources and those potentially addressing microfinance opportunities in the community may facilitate greater access to prevention education. Multilevel interventions focused on finance and empowerment education focusing on sexual concurrency, IPV, and HIV risk behavior have potential for addressing HIV vulnerability among this population |
| Frye, V., Koblin, B., Chin, J., Beard, J., Blaney, S., Halkitis, P., … & Galea, S. (2010) | About 40% of this sample was between 23–24 years old; 31% identified as Hispanic, 30% identified as Black, 21% identified as White and 18% identified as Other; a majority of participants were post-high school graduates (27%) or have completed college or more education (44%); only 16% of participants earned $40 k or more | Roughly half of the sample’s respondents were consistent condom users during both receptive and insertive anal intercourse; living with a partner and sex while high or buzzed on drugs were negatively associated with consistent condom use | Investigators must explore factors "upstream" and around at the social and physical context that constitutes the risk environment for MSM. Multi-level studies of the neighborhood environment are crucial to these efforts, as are qualitative inquiries into the lived experience of the neighborhood and how this relates to sexual behavior |
| Frye, V., Nandi, V., Egan, J. E., Cerda, M., Rundle, A., Quinn, J. W., … & Koblin, B. (2017) | Mean age Black: 32 years. Mean age White: 34 years. 25% & 4% of Black & white participants (respectively) had high school degree/GED or less; 44% & 17% of Black & white participants were unemployed. 37% & 12% of Black & white participants had annual income below $10,000. Almost 9% & 2% of Black & white participants (respectively) had incarceration history. 4.5% & 5% of Black & white participants were married or partnered (with a man) | This study found little evidence to support the association between social disorganization and sexual risk behaviors among MSM. Less physical disorder and ethnic heterogeneity in neighborhoods protective against condomless anal sex with serodiscordant partner among Black MSM. Cleaner neighborhoods indicate higher risk for White MSM | Future studies should examine how non-geographically bounded communities (e.g. social networks) and neighborhood characteristics closer to actual sex acts |
| Genberg, B. L., Gange, S. J., Go, V. F., Celentano, D. D., Kirk, G. D., Latkin, C. A., & Mehta, S. H. (2011) | 75% male, 95% African American, 57% did not have a high school diploma. 66% never married. Median age was 35 years. Median years injected was 14. Approximately 50% reported injection daily or more frequently. 65% injected heroin & cocaine (speedball). 58% resided in most deprived (4th quartile) neighborhoods | Drug cessation significantly less likely to occur to happen in most deprived neighborhoods. Moving from deprived neighborhoods increased odds of cessation | Examine appropriateness of 3 years as a measure of long-term changes in behaviors. Determine mechanisms through which relocation and neighborhood deprivation impact long-term changes in drug use |
| Gindi, R. M., Sifakis, F., Sherman, S. G., Towe, V. L., Flynn, C., & Zenilman, J. M. (2011) | Majority of the 307 participants were black, they were evenly divided by gender and had a mean age of 33 years. One-third (34%) lived in the Census tracts in the top quartile of HIV/AIDS case rates in Baltimore City. Almost half (43%) reported 3 or more partners in the past 12 months. Casual partnerships were most common (44%), with 39% of partnerships classified as main and 16% as exchange. Participants reported concurrency in 67% of partnerships and suspected partner concurrency in 56% of partnerships | Almost half the population reported choosing spatially assortative partners. Participants living in HIV core areas more likely to choose spatially assortative partners than residents of non-core areas after adjusting for partnership type, gender, & number of partners. Women engaging in exchange sex most likely to report spatial assortativity. Contextual factors that may impact geography of partner selection include access to public transportation, residential segregation, natural boundaries (rivers & roads) & access to social institutions that create meeting opportunities | There is a need for more research on geographical and contextual factors in HIV/STD prevention. Capitalize on the spatial proximity of partners in high-prevalence areas by supplementing individual focus messages with social marketing campaigns. Shared geographical space may be the underlying mechanism by which social norms are developed in a network. So there is a need to assess the impact of social norms and attitudes on sexual behavior based on geographical context |
| Haley, D. F., Haardorfer, R., Kramer, M. R., Adimora, A. A., Wingood, G. M., Goswami, N. D., … & Cooper, H. L. F. (2017) | Average age: 44 years old. 83% African American, 67% had annual household incomes of ≤ $18,000. 72% HIV-infected. 42% reported condomless vaginal intercourse, 7% reported anal intercourse, and 4% reported condomless anal intercourse in the last 6 months. On average, participants lived in Census tracts where 16% of residents were unemployed, 29% lived in poverty, and roughly half of housing units were renter-occupied | Social disorder and social disadvantage not associated with condomless vaginal intercourse. Greater social disorder was associated with less anal intercourse and condomless anal intercourse | Longitudinal and qualitative studies needed to establish the causality of relationships and to better understand pathways through which neighborhood characteristics shape sexual risk, and inform development of future multilevel interventions to improve and reduce HIV/STI transmission |
| Heimer, R., Barbour, R., Palacios, W. R., Nichols, L. G., & Grau, L. E. (2014) | Sample was 62.1% male, 81.9% White, 9.7& Hispanic, 6.3% African American | Injection drug users in more economically disadvantaged areas are engaging in more HIV risk behaviors than those in the neighboring suburban communities. In more disadvantaged areas, there is less access to harm reduction services and less awareness and education about injection-associated diseases | Comprehensive, integrated programs are needed to improve public health responses for injection drug users, and should include a dual-diagnosis approach to providing harm reduction service |
| Kelly, B. C., Carpiano, R. M., Easterbrook, A., & Parsons, J. T. (2012) | Five analytic samples (one for each outcome within the last 3 months), which ranged in size from 584 (82.3%) and 661 (931.1%). Any insertive (585); any receptive (584); barebacker identity (661); Party and play (641); and meet a man via internet for sex (621) | Gay enclave (a substantially gay population, gay institutions, and conspicuous gay subcultures. Levine (1979)) residents were not directly associated with sexual risk behaviors but with PnP. Having a gay-centric network was associated with higher odds of engaging in IAI, engaging in PnP, and using the internet to find sexual partners. Social networks has the highest impact of determining participation in risky sexual behaviors | A better contextualization of health risk that moves beyond a focus on individual-level factors and considers the role of the social contexts in which the gay community's health behaviors take place |
| Kerr, J. C., Valois, R. F., Siddiqi, A., Vanable, P., & Carey, M. P. (2015) | African American adolescents between the ages of 14 and 17, the majority of the sample were and females (59%); mean age of the sample was 15.1. The majority of the sample was low income as 76% of the sample qualified for free or reduced price school lunch | Participants from the Southeastern communities had higher risk for HIV/STI. Of the neighborhood dyads, participant-reported low quality neighborhoods faced greater risk of STI/HIV | Further examine the relationship between region and neighborhood with probability samples and qualitative research |
| Knittel, A. K., Snow, R. C., Riolo, R. L., Griffith, D. M., & Morenoff, J. (2015) | N/A; data for model development was obtained from African American residents of 270 metropolitan areas defined in the 1980 US Census; men in the labor force and non-institutionalized women | When community incarceration rates are high, there is an increase in the number of sexual partnerships at the community level over five years. This may explain differences in the numbers of sexual partners, increased rates of STDs and HIV observed in these communities. There is more of an effect for men than women | Policy's that reform the criminal justice system that enable the maintenance of inmate's relationships with partners and family to reduce the instability of partnerships for men who have been incarcerated. Ways to decrease the cost of relationship maintenance |
| Koblin, B. A., Egan, J. E., Rundle, A., Quinn, J., Tieu, H. V., Cerdá, M., … & Frye, V. (2013) | The average age was 32.4, 34% of the sample was white; 31% Hispanic, 23% Black/African American; and 11% another ethnicity. 31% were born in NYC, over 50% of men reported possessing at least a college degree, 5% reported a lifetime history of incarceration | MSM influenced by the environments in which they socialize and have sex as well as the duration and intensity of exposure to neighborhood environments. Men perceived their home, social and sexual neighborhoods in different ways. They identified their social neighborhoods as being the largest while the size of their sexual neighborhoods was the smallest | The research provides groundwork for the development of structural and neighborhood-based interventions, as well as for identifying approaches that augment individual-level interventions through community development initiatives and health messages for MSM specific to their neighborhood context |
| Koblin, B. A., Egan, J. E., Nandi, V., Sang, J. M., Cerda, M., Tieu, H.-V.,... Frye, V. (2017) | Average age 32.1 (SD = 103); 31.9% White (non-Hispanic); 30.4% Latino; 25.2% Black/African American; 12.5% reported another race/ethnicity; men (87.3%) self-identified as gay, homosexual, queer, or same-gender loving; 49.3% have at least a college degree; 63.3% were employed; 26.3% average personal income of less than $10,000 per year, 47.9% they did not have enough money for necessities in the prior 3 months | Most men in study report incongruence among neighborhoods—1 in 6 reported complete congruence among home, social, and sex neighborhoods. Risk behaviors highest among MSM reporting being Black and/or Latino, with lower educational levels, lower personal income, and greater financial insecurity. They were more likely to have been born in NYC with close connections to kin network and less mobile financial and lowest mean score of outness. White men, with higher education, higher personal income, and born outside of NYC report neighborhood congruence of all neighborhoods. This means they have higher control over their living situation. Neighborhood incongruence associated with sexual risk | Longitudinal studies are needed to better understand how these relations change over time. More research is needed to understand how neighborhood/geography impacts the lives of men living in smaller cities in rural areas. Studies should include incorporating the complexities of how different spaces and places impact the health and behavior of MSM to reach different populations |
| Latkin, C. A., Curry, A. D., Hua, W., & Davey, M. A. (2007) | Participants identified as 97% African American. 59% male and 22% HIV positive; 81% reported unemployment, 63% on public assistance, and 19% had been incarcerated, and 14% homeless. Participants had a median age was 43 years and 47% had completed less than 11 years of school. Virtually all (97%) of participants reported a history of heroin or cocaine use; 27% reported recent injection drug use and 36% reported recent crack cocaine smoking | Statistically significant direct associations were observed between neighborhood disorder and psychological distress; neighborhood disorder and sexual risk behaviors; and neighborhood disorder and drug use. There were also significant indirect associations of neighborhood disorder on sexual risk behaviors. These findings reinforce the significance of neighborhood disorder in relation to sexual risk behaviors and drug use | Future focuses should be centered on community programs that mitigate the norms of violence and drug abuse, improve relationships between communities and law enforcement, and economic development |
| Lutfi, K., Trepka, M. J., Fennie, K. P., Ibanez, G., & Gladwin, H. (2015) | Non-Hispanic African Americans between eh ages of 15–44. Majority were male, had a HS diploma, and were under the age of 35 | Racial residential segregation was associated with risky sexual behavior. This association was stronger with the centralization and concentration dimensions of racial residential segregation. These findings suggest that risky sexual behavior was more strongly associated with neighborhoods with high concentrations of non-Hispanic blacks located in an urban core | Examination of prevention strategies (STI education and methods to prevent partner instability) in racially segregated residential areas and the role that they may play in lowering risky sexual behaviors |
| Martinez, A. N., Lorvick, J., & Kral, A. H. (2014) | 61% reported usually sleeping in Census tracts with 20% or more households living in poverty; 12% tested positive for HIV infection at the time of interview; 35% reported syringe sharing in the past 6 months, 9% reported at least one non-fatal overdose in the past 12 months | The mean activity space distance in this sample was 1.5 miles. Only 9.6% of participants had a syringe exchange program located along their activity space. This study observed an association between increases in activity space distance with a decrease in odds of being HIV positive. An increase in residential transience, or the number of different locations slept in by participants in a 6 month time period, was associated with higher odds of syringe sharing. Activity space distance was not independently associated with overdose or syringe sharing in this study | Future approaches should examine the types, frequency, and timing of habitually visited locations of injection drug users for targeted interventions. Document all geographic locations that an individual has direct contact with as a result of his or her day to day activities through diaries or smartphones |
| Mustanski, B., Birkett, M., Kuhns, L. M., Latkin, C. A., & Muth, S. Q. (2015) | Egos (n = 167): median age is 20.1, 100% male, 54.5% Black, 22.2% Latino, 83.9% identified as gay, majority (95.2%) reported stable housing. 41.3% of egos reported high school graduate or less education, and majority were not employed. Alters (n = 837): median age 22.4, 91.6% identified as male, with 7.5% identifying as female and 0.8% identifying as transgender. 49.0% identified as Black, 21.0% identified as Latino, and 22.6% identified as White. 75% of egos identified as gay/lesbian, 15.3% identified as bisexual, and 7.8% identified as heterosexual | BYMSM more likely to have sex partners identified as main partner and report strong relationships with partners. Black YMSM had greater proportion of sexual partners from high HIV prevalence neighborhoods than Latino, White, and other YMSM. Black and Latino YMSM had denser sexual networks than White YMSM. Sex partners more likely than non-sex partners to be either drug partners or to be support network members | To eliminate racial inequities in HIV we may need to consider how network and geographic factors can be addressed through structural interventions in concert with prevention at the individual level |
| Nandi, A., Glass, T. A., Cole, S. R., Chu, H., Galea, S., Celentano, D. D.,... Mehta, S. H. (2010) | 36% of participants had an age greater than or equal to 35 years at baseline. The majority of participants identified as male (75%) and Black (95%), and a majority reported less than high school education (56%), unemployed in the past 6 months (77%, and had a formal income less than $2500 in the past 6 months (79%). 36% of participants reported that they were HIV positive, 48% reported that their age at first injection was less than 20 years old, and 30% reported needle sharing | IDUs living in more impoverished neighborhoods were less likely to stop injecting drugs, independent of individual level covariates. Neighborhood environment may be an important determinant of drug injection | Consider the use of IPW (inverse probability weights) as a method to address confounding by determinants of neighborhood selection, specifically for handling time-varying confounders affected by prior exposure |
| Neaigus, A., Jenness, S. M., Reilly, K. H., Youm, Y., Hagan, H., Wendel, T., & Gelpi-Acosta, C. (2016) | The sample identified as 60.1% male, 79.6% non-Hispanic Black, and 19.6% Hispanic race/ethnicity; the median age was 40 years; 23.9% reported non-heterosexual activity; 37.7% had ever been homeless (past 12 months); 16.6% had ever injected drugs; in the past 12 months 76.7% used non-injection drugs; 90.1% engaged in condomless vaginal or anal sex; 9.6 tested HIV positive; Reside in Brooklyn (53.2%), Manhattan (31.4%), Bronx (13.6); and Queens (1.8%) | Community sexual bridging in NYC is common meaning the risk of heterosexually transmitted HIV from condomless sex with current or former drug injectors is considerable. Higher bridging communities had a greater percentage of Black or Hispanic residents. Hidden bridging communities were more likely to include Black residents, which may facilitate the spread of heterosexually transmitted HIV among Black women in lower HIV-prevalence communities. It is also associated with homelessness and subsequent geographic mobility | Describing and understanding patterns of community sexual bridging can enhance geographically targeted HIV interventions in urban areas. Bridging communities are important to understand in HIV prevention/intervention |
| Pachankis, J. E., Eldahan, A. I., & Golub, S. A. (2016) | Majority of participants were gay-identified, single, HIV-negative, had completed college or were currently enrolled in college, were either employed full time or enrolled as a student. Over one third reported growing up working class or poor. One third were from a hometown with a population of less than 50,000; 13.2% were from non-US hometowns and were moving from outside the USA. Most currently lived in a neighborhood with a higher-than-average density of same-sex households, earned less than $30,000 per year, knew at least one person in NYC upon arrival and had arrived in the past 6 months | Participants reported encountering moderate degrees of hometown stigma and discrimination and moved to NYC to escape stress & pursue opportunity. Men who escaping stress were more likely to live outside a gay-dense neighborhood upon NYC arrival. Hometown interpersonal discrimination strongly related to all assessed health risks, including HIV risk, substance use, alcohol problems, & mental health problems, although hometown structural stigma climate was associated with lower odds of heavy drug use | Need for more programs that facilitate social support outside of sex risk and substance use sciences, encourage healthy goal pursuit, and promote healthy identity development away from the threat of hometown discrimination might possess particular promise. Research utilizing longitudinal designs and matches samples of non-migrants can extend the results of this research to establish causal threats to the health of this sizable and vulnerable segment of the urban population |
| Parrado, E. A., & Flippen, C. (2010) | The average Hispanic immigrant in the area is nearly 30 years-old, has 7.6 years of education, and earns $14 hourly. Less than 40% of migrant men are married and residing with their spouse; the vast majority are unaccompanied. The average duration of residence in Durham area is less than 4.4 years, only 64% of migrant men reported speaking any English, and 8% reported speaking English well or very well | Likelihood of CSW varies in conjunction with accumulated time in Durham, though not in linear fashion. CSW increases during the first years after migration as migrants gain financial resources, peaks, and then declines over time in conjunction with developing social bonds and attachments. Share of community who are recent migrants positively associated with CSW use. Neighborhood concentration of Hispanic migrants tends to overlap with the concentration of single men. Social disorganization positively correlate with CSW | Move beyond individualistic approaches and address the social milieu in which migrants operate, improving neighborhood conditions and affecting the structural impediments to positive sexual adaptation in the U.S |
| Quinn, K., Voisin, D. R., Bouris, A., & Schneider, J. (2016) | Average age of 23.8 years, over 90% had at least a high school degree, and two-thirds were working full- or part time. One-third reported any lifetime use of hard drugs and 15.2% reported hard drug use over the previous 3 months (cocaine, amphetamines, inhalants, sedatives or sleeping pills, hallucinogens, or opioids), 40% reported daily tobacco use, over half reported daily marijuana use. 20% reported having condomless anal intercourse with an unknown or different status partner. 84.8% currently taking HIV medications, the entire sample reported high rates of exposure to community violence | Findings establish that exposure to community violence was a significant correlate of low medication adherence and unprotected anal sex among YBMSM. Significant differences among HIV positive YBMSM with regards to poor mental health, higher substance use, condomless anal intercourse and lower medication adherence based on levels of exposures to community violence. Secondary HIV prevention initiatives for persons living with HIV should address exposure to community violence | Using larger samples and longitudinal designs, might better estimate whether lifetime or past 12 month exposure to community violence is associated with health-related outcomes across varying time intervals for this populations. Future longitudinal approaches are also needed to establish the temporal ordering between exposures to community violence and the health-related factors observed among this study |
| Raymond, H. F., Al-Tayyib, A., Neaigus, A., Reilly, K. H., Braunstein, S., Brady, K. A., … & German, D. (2017) | The mean number of men per city was 511. The majority (80%) of men reported only MSM behavior in the last 12 months. Baltimore reported lowest MSM behavior (66.8%) in the past 12 months. Percent of men who reported a female partner varied across sites, with a range of 0% to 5%. All sites had low percentages of MSM and IDU behavior in the past 12 months | Findings demonstrated high correlation (0.93) between the percentage of reported living HIV cases attributed to heterosexual sexual contact, and a moderate nonsignificant correlation (0.49) between the percentage of men who had sex with men and women (MSMW). Cities with high levels of poverty and African American/Black residents had higher levels of MSMW and higher levels of heterosexual female cases | More research to understand facts such as financial instability, incarceration, internalized homonegativity, society gay stigma, gender role conflict, and childhood sexual abuse among African American/Black communities and African American/Black MSM contribute to the potential bridging of HIV from MSM to female heterosexuals |
| Raymond, H. F., Chen, Y. H., Same, S. L., Catalano, R., Hutson, M. A., & McFarland, W. (2014) | 165 HIV-negative BMSM, 170 HIV-negative transfemales, and 188 HIV-negative WMSM, (demographic data reported for each group separately), | BMSM & transfemales more similar in SES than they are to WMSM. WMSM more likely to have college education or greater, higher incomes and health insurance. WMSM had highest SES scores while BMSM and transfemales had similar, lower levels of SES. BMSM and transfemales have higher IV drug use than WMSM. All populations similar in regards to number of partners in drug use, numbers of partners in the past 6 months, and sexual risk taking. BMSM had more acts of potentially discordant unprotected anal intercourse and more partners | Interventions must take into account the very specific must take into account the very specific contexts and patterns of behavior related to HIV risk taking on a subpopulation basis. Future research will by necessity address a wide range of neighborhood effects (lack of services, domestic violence, neighborhood based partnering) that may have a relationship with HIV risk taking |
| Rothenberg, R. B., Dai, D., Adams, M. A., & Heath, J. W. (2017) | HIV prevalence in lower-risk area 12% compared to 17% in higher-risk area. Sample more than 90% African American. 1:1 male-to-female ratio. Approximately 70% single, 40% had high school diploma/GED. Homelessness less in lower-risk areas and among women (male: lower, higher: 10%, 27%; female: lower, higher: 6%, 21%). Over 90% of men in both areas had been incarcerated; proportion varied from 63% (lower risk) to 77% (higher risk) in women. Majority of participants identified as heterosexual. Crack use about 2 × higher in higher- risk areas. Heroin and drug injection highest among men in the higher-risk area (22%) and anal sex in the past 6 months was highest among women in the higher-risk areas (12%) | Higher risk areas demonstrated greater social and geographic compactness. Indicates greater concentration of HIV risk in higher risk areas. Endemic HIV transmission in at-risk communities is maintained though the interaction of intense compound risk taking, geographic compactness, and a conducive network structure | Further exploration of the interaction of the multiple factors that affect transmission is likely to provide greater insight into the dynamics |
| Rudolph, A. E., Crawford, N. D., Latkin, C., Fowler, J. H., & Fuller, C. M. (2013) | 10.5% HIV positive, 7.14 HIV status unknown, 15.13 total income > 10,000, 68.5% homeless in past 6 months, mostly African American 55.8%, 34.4% Hispanic, 74.8% male | Membership in high HIV prevalence networks was not random; individuals who recruited (or were recruited by) HIV positive individual more likely to be HIV positive and strength/significance of association did not diminish with increasing degrees of separation. Association between exchanging sex, crack use, and increased HIV prevalence in drug using networks. High HIV prevalence network members were more likely to be recruited in neighborhoods characterized by increased inequality, higher-valued owner-occupied housing, and a greater proportion of Latinos | Network-driven approaches which also take features of the social/structural environment into account may be appropriate to reduce HIV transmission and/or support care seeking and HIV drug adherence for HIV positive individuals, but further research is needed to better characterize neighborhood factors associated with HIV-clustering among drug-using populations in NYC |
| Rudolph, A. E., Linton, S., Dyer, T. P., & Latkin, C. (2013) | Predominately African American (96.9%), the median age was 42 years, 10.8% reported being HIV positive, and 30.7% reported > = 1 exchange sex partner in the last 90 days. Median network size was 8 and median number of sex network members in the past 90 days was 1. Women reported living in their current neighborhood for a median 12 months and 65.1% reported spending most/all of their time in that neighborhood. Problems on their block more than half reported: (1) selling drugs, (2) groups of teenagers hanging out on the street, (3) litter/trash on the streets, (4) people fighting arguing, and (5) people saying insulting things or bothering other people when they walk down the street 6. vacant housing | Crack/coke use, HIV infection, & homelessness associated with exchange sex in unadjusted models. Association between homelessness and exchange sex may be explained by perceived neighborhood disorder & social network variables. High-risk network members and multiplex networks participate in higher risk sexual behaviors, having a greater proportion of network members using drugs and who perceived both social support and drug support were associated with an increased likelihood of exchange sex in the unadjusted model | Structural interventions that provide targeted assistance or referrals to subsidized assistance to women who exchange sex may be warranted. Structural interventions that target neighborhoods are need that address social disorder. Especially ones focusing on employment, quality of housing stock, and educational opportunities. More research is needed to better characterize exchange sex partners and to describe how they differ from other types of partners so that more effective network-based interventions can be developed |
| Senn, T. E., Walsh, J. L., & Carey, M. P. (2016) | Predominantly socioeconomically disadvantaged, with at least half of participants reporting an income < $15,000/year (53%), a high school or less education (63%), and current unemployment (50%). Participants also lived in socioeconomically disadvantaged Census tracts, with a median per capita income of $14,267 per year. Median percentage of college graduates in these Census tracts was 13% | Community violence associated with sexual risk behavior in a sample of adults attending an urban STI clinic. Association btw community violence and sexual risk behavior remained after controlling for individual and Census tract-level SES. Associations differed for men and women; for men, higher rates of community violence associated with more partners in the past three months. Women: community violence associated with more episodes of unprotected sex with a non-steady partner | Consider potential sex differences and investigate multiple sexual behavior outcomes. Longitudinal research is needed to clarify the direction of effects |
| Sterk, C. E., Elifson, K. W., & Theall, K. P. (2007) | The parent study sample included 336 HIV negative African American female drug users. Ages ranged from 18 to 59 (mean age of 38 years). Over one half had less than a complete high school education (53%), and approximately 38% were married (including common law) at the time of baseline assessment. 72% reporting any lifetime physical abuse, 60% sexual abuse, 87% emotional abuse. 13% never being in jail or prison, and 48% worked legally in the year prior to baseline interview. 79% were primarily crack cocaine smokers, 8% were injection drug users (IDUs) who did not smoke crack, and 13% were IDUs who also smoked crack | Women in the study's individual HIV risk-reduction is associated with individual characteristics, community norms, opportunity structures, and environmental conditions. The findings contribute to the ongoing debates on community context and health and the link between individual actions and environmental cues | Inclusion of data collection from a larger cross-section of residents to determine how individual actions and community context need to be studied congruently, allowing a focus on individual agency as well as collective efficacy |
| Stevens, R., Gilliard‐Matthews, S., Nilsen, M., Malven, E., & Dunaev, J. (2014) | 30 females who identified as African American (43%), Latina (40% of Dominican or Puerto Rican descent), and both (17%). Ages ranged from 13 to 20, with a mean age of 17. All participants were in high school or in community college at the time of the interview. One half reported having engaged in sexual intercourse in the past. The sexually active participants were significantly older and more likely to report alcohol and marijuana use than nonactive girls. No other significant difference in living situation or sexual attraction. Although their sexual experience levels varied, common themes emerged from their stories, particularly their rationales related to sexual decision making | Neighborhood/social environment impact girls/young women sexual decision making in 3 ways: 1. severe & persistent structural challenges (chronic disinvestment, high poverty & unemployment) reflected in neighborhood fabric. Lack of investment created neighborhood disorder evidenced by high crime and violence. 2. Result of the economic depression in area and the effect on parental supervision & monitoring. 3. High level of visible drug trafficking, drug use, and abuse destroy neighborhood cohesion and increase violence and crime | Consider neighborhood, social, and new media environments as not only the contexts in which individual decision making occurs, but also as systems ripe for targeted intervention |
| Stevens, R., Icard, L., Jemmott, J. B., O'Leary, A., Rutledge, S., Hsu, J., & Stephens-Shields, A. (2017) | African American MSM whose age ranged from 18 to 69 years (mean = 41.7; SD = 10.7); About 20.0% of participants engaged in transactional sex. About 29.7%said they were HIV-positive. About 52.7%did not complete high school or obtain a GED, and 62.6% earned less than $851 per month. About 36.4% lived in their own house or apartment | Participants were more likely to engage in transactional sex if they did not complete high school, demonstrated elevated drug use, and if neighborhood had elevated non-completion rate for high school | Examine motivational factors for substance use and sexual engagement. Examine factors related to housing stability and transactional sex for MSM |
| Tobin, K. E., Latkin, C. A., & Curriero, F. C. (2014) | Majority had at least 12 years of education (82%), nearly half were working full or part time, about half identified as gay and nearly one-third self-report HIV positive status (31%). Substance use with social networks included alcohol only (27%), alcohol and marijuana (27%), marijuana only (16%), and combinations of alcohol, crack, and heroin (20%) | Spatial concentration of drug/alcohol use places may have both health promoting and deleterious effects on the health of African American MSM. Gay neighborhoods or enclaves also may have risk factors associated with them. Spatially focused alcohol/drug areas may be one mechanism for mixing individuals from diverse social networks, thus contributing to disease transmission dynamics | Determine underlying geographic characteristics or migratory patterns that could explain clustering by identified characteristics—desire for privacy, distance from residence, and the racial composition of the area |
| Tobin, K. E., Hester, L., Davey-Rothwell, M. A., & Latkin, C. A. (2012) | The mean age of this sample was 43.9 (SD = 7.53) years old, 66% male, and 95% of this sample reported their sexual identity as straight. In a 6 month period proir to the study, 90% reported unemployment, 28% reported homelessness, and 28% reported incarceration. Greater proportion of sex exchangers were younger, female, bisexual, homeless, smoked crack and injected drugs in the past 6 months | Findings from this study demonstrated spatial clustering of sex exchangers. Perceived norms aligned with spatial clustering of sex exchangers. A specific housing complex of East Baltimore contained the highest concentration of sex exchangers. Participants reporting sex exchange behaviors spatially cluster more. Regions with increased density of sex exchange spatially aligned with regions that with high density of participants reporting that a few to all friends engaging in sex exchange and no friends who would disapprove of sex exchange | Future studies should examine spatial aspects of social networks of sex exchangers within and external to the neighborhood of residence |
| Voisin, D. R., Hotton, A. L., & Neilands, T. B. (2014) | The overall sample was composed of 563 African American youth (219 boys and 344 girls). Mean age was 16.1 (SD = 1.2) and the majority of boys and girls (61 and 59%, respectively) reported receiving ''free school lunch.'' | Community violence associated with risky sex and sexual debut, through pathways of aggression and negative peer norms towards safer sex for boys and girls in this study | These findings indicate a need for more structural interventions focusing on violence in the interests of reducing HIV risk, as well as a need longitudinal studies with larger samples |
| Williams, C. T., & Latkin, C. A. (2007) | 70% of participants reported using heroin, crack and/or cocaine in the past year. 49% were drug injectors, mean age 38, 39% females, 53% received a high school education, 80% not working, 70% having monthly incomes less than $500, 60% reported having a main (sexual partner), depressive symptom scores were at or above the threshold for clinical depression, associated with current drug use, 18% self-reported being HIV positive | Negative effects of neighborhood disadvantage were observed on drug use. Neighborhood poverty and drug influences in the network were positively associated with current drug use, network social support and ties to employed person were protective of drug use. Neighborhood poverty is robust in the sense that its effects are not attenuated when network attributes are taken into account. Included street-recruited drug users who are often marginalized, and neighborhood environment impacts them differently | Future research is needed to understand the aspects of social and physical environments that matter for drug outcomes before effective policy and research interventions can be developed |