Living in a Disadvantaged Neighborhood May Increase HIV Risk

Living in a disadvantaged urban neighborhood can increase a male resident's risk of contracting HIV, according to researchers at the Johns Hopkins Bloomberg School of Public Health. Their study related disadvantaged neighborhoods to stress and then linked individual stress to increased injection drug use in male study participants. This is the first empirical study that illustrates how neighborhood characteristics may directly lead to HIV infection. The study is published in the January 2005 issue of Health Psychology.

Carl A. Latkin, PhD, lead author of the study and an associate professor in the Bloomberg School of Public Health’s Department of Health Policy and Management, explained that HIV rates are known to differ by geographic location and that disadvantaged urban areas tend to have high rates of HIV.

He said, “Past studies have shown a consistent relationship between socioeconomic status and health, but the ways in which neighborhood characteristics impact health behaviors are poorly understood. Our findings show how neighborhood characteristics and stressors, such as crime, abandoned buildings, loitering, unemployment, crowding and litter lead to greater depression. Individuals who have high levels of depression tend to take more illicit drugs and engage in more risk behaviors.”

The researchers examined data from a survey of 701 injection drug users from the Self-Help in Eliminating Lethal Disease (SHIELD) Study, an HIV prevention intervention in Baltimore, Md. They found that psychological distress or feelings of hopelessness and helplessness is higher in more socially deprived neighborhoods and that stress led to greater injection frequency and needle sharing. They also learned that an increase in injection drug use leads drug users to share drug equipment. The researchers did not see a clear correlation between stress and injection frequency in female study participants.

The researchers note that depression is often viewed as a personal or individual attribute that should be treated with medication or psychotherapy. However, the results of this study suggest that depression may be due in part to living in stressful, disadvantaged neighborhoods. Needle exchange programs, neighborhood revitalization projects and assistance with obtaining legal employment can improve neighborhood quality and reduce stressors, according to the study authors.

“The perceived lack of control over the environment or feelings of entrapment due to fear of those involved in drug economy and other criminal activities may be a constant threat to self and self-concept for some neighborhood residents. As it not feasible or desirable to treat large numbers of depressed individuals with therapy or medication, preventive interventions are needed to address impoverished neighborhood residents’ physical and social disorder,” said Dr. Latkin.

The study authors were supported in part by grants from the National Institute on Drug Abuse.

Co-authors of the study from the Johns Hopkins Bloomberg School of Public Health include Chyvette T. Williams, Jian Wang and Aaron D. Curry.