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Social Stability and HIV Risk Behavior: Evaluating the Role of Accumulated Vulnerability

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Abstract

This study evaluated a cumulative and syndromic relationship among commonly co-occurring vulnerabilites (homelessness, incarceration, low-income, residential transition) in association with HIV-related risk behaviors among 635 low-income women in Baltimore. Analysis included descriptive statistics, logistic regression, latent class analysis and latent class regression. Both methods of assessing multidimensional instability showed significant associations with risk indicators. Risk of multiple partners, sex exchange, and drug use decreased significantly with each additional domain. Higher stability class membership (77%) was associated with decreased likelihood of multiple partners, exchange partners, recent drug use, and recent STI. Multidimensional social vulnerabilities were cumulatively and synergistically linked to HIV risk behavior. Independent instability measures may miss important contextual determinants of risk. Social stability offers a useful framework to understand the synergy of social vulnerabilities that shape sexual risk behavior. Social policies and programs aiming to enhance housing and overall social stability are likely to be beneficial for HIV prevention.

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References

  1. Blankenship KM, Bray SJ, Merson MH. Structural interventions in public health. AIDS. 2000;14(Suppl 1):S11–21.

    Article  PubMed  Google Scholar 

  2. Blankenship KM, Friedman SR, Dworkin S, Mantell JE. Structural interventions: concepts, challenges and opportunities for research. J Urban Health. 2006;83(1):59–72.

    Article  PubMed  CAS  Google Scholar 

  3. Sweat MD, Denison JA. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS 1995;9 Suppl A:S251-7.:S251-S257.

  4. Klein C, Easton D, Parker R. Structural barriers and facilitators in HIV prevention: A review of international research. In: O’Leary A, editor. Beyond condoms: alternate approaches to HIV prevention. New York: Kluwer Academic Plenum Publishers; 2002. p. 17–46.

    Google Scholar 

  5. AIDS Administration. The Baltimore HIV/AIDS Epidemiological Profile, Second Quarter 2006. Department of Health and Mental Hygiene.

  6. Nelson KE, Galai N, Safaeian M, Strathdee SA, Celentano DD, Vlahov D. Temporal trends in the incidence of human immunodeficiency virus infection and risk behavior among injection drug users in Baltimore, Maryland, 1988–1998. Am J Epidemiol. 2002;156(7):641–53.

    Article  PubMed  Google Scholar 

  7. AIDS Administration. Baltimore City HIV/AIDS Epidemiological Profile, Fourth Quarter 2007.

  8. Adimora AA, Schoenbach VJ, Doherty IA. HIV and African Americans in the southern United States: sexual networks and social context. Sex Transm Dis. 2006;33(7 Suppl):S39–45.

    PubMed  Google Scholar 

  9. Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008;372(9635):337–40.

    Article  PubMed  Google Scholar 

  10. Howard G, Anderson RT, Russell G, Howard VJ, Burke GL. Race, socioeconomic status, and cause-specific mortality. Ann Epidemiol. 2000;10(4):214–23.

    Article  PubMed  CAS  Google Scholar 

  11. Adler NE, Rehkopf DH. U.S. disparities in health: descriptions, causes, and mechanisms. Annu Rev Public Health. 2008;29:235–52.

    Article  PubMed  Google Scholar 

  12. Schulz A, Israel B, Williams D, Parker E, Becker A, James S. Social inequalities, stressors and self reported health status among African-American and white women in the Detroit metropolitan area. Soc Sci Med. 2000;51:1639–53.

    Article  PubMed  CAS  Google Scholar 

  13. Tucker JS, D’Amico EJ, Wenzel SL, Golinelli D, Elliott MN, Williamson S. A prospective study of risk and protective factors for substance use among impoverished women living in temporary shelter settings in Los Angeles County. Drug Alcohol Depend. 2005;80(1):35–43.

    Article  PubMed  Google Scholar 

  14. O’Leary A. Substance use, HIV. Disentangling the nexus of risk. J Subst Use. 2001;13:1–3.

    Google Scholar 

  15. Farley TA. Sexually transmitted diseases in the Southeastern United States: location, race, and social context. Sex Transm Dis. 2006;33(7 Suppl):S58–64.

    PubMed  Google Scholar 

  16. Friedman SR. HIV-related politics in long-term perspective. AIDS Care Psychol Socio-Med Aspects AIDS/HIV. 1998;10(Suppl 2):93–103.

    Google Scholar 

  17. Farmer P, Connors M, Simmons J., editors. Women, poverty, and AIDS: Sex, drugs, and structural violence. 1996; Monroe, Maine: Common Courage Press.

  18. Wechsberg WM, Dennis ML, Stevens SJ. Cluster analysis of HIV intervention outcomes among substance-abusing women. Am J Drug Alcohol Abuse. 1998;24(2):239–57.

    Article  PubMed  CAS  Google Scholar 

  19. Moore J, Schuman P, Schoenbaum E, Boland B, Solomon L, Smith D. Severe adverse life events and depressive symptoms among women with, or at risk for, HIV infection in four cities in the United States of America. AIDS. 1999;13(17):2459–68.

    Article  PubMed  CAS  Google Scholar 

  20. Lawrence JSS, Eldridge GD, Reitman D, Little CE, Shelby MC, Brasfield TL. Factors influencing condom use among African American women: implications for risk reduction interventions. Am J Commun Psychol. 1998;26(1):7–28.

    Article  Google Scholar 

  21. Singer M, Clair S. Syndemics and public health: reconceptualizing disease in bio-social context. Med Anthropol Q. 2003;17(4):423–41.

    Article  PubMed  Google Scholar 

  22. Singer MC, Erickson PI, Badiane L, Diaz R, Ortiz D, Abraham T, et al. Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context. Soc Sci Med. 2006;63(8):2010–21.

    Article  PubMed  Google Scholar 

  23. Straus R, Bacon SD. Alcoholism and social stability; a study of occupational integration in 2,023 male clinic patients. Q J Stud Alcohol. 1951;12(2):231–60.

    PubMed  CAS  Google Scholar 

  24. Gerard DL, Saenger G. Out-patient treatment of alcoholism: a study of outcome and its determinants. Toronto: University of Toronto Press; 1966.

    Google Scholar 

  25. German D. Social stability and HIV risk: exploring the role of multidimensional social vulnerability (Doctoral dissertation). Available from Dissertations and Theses Database (UMI No. AAT 3357168). 2009.

  26. Angel RJ, Lein L, Henrici J. Poor families in America’s health care crisis. New York, NY: Cambridge University Press; 2006.

    Book  Google Scholar 

  27. Mehta SH, Thomas DL, Sulkowski MS, Safaein M, Vlahov D, Strathdee SA. A framework for understanding factors that affect access and utilization of treatment for hepatitis C virus infection among HCV-mono-infected and HIV/HCV-co-infected injection drug users. AIDS. 2005;19(Suppl 3):S179–89.

    Article  PubMed  Google Scholar 

  28. Kalichman SC, Simbayi LC, Kagee A, Toefy Y, Jooste S, Cain D, et al. Associations of poverty, substance use, and HIV transmission risk behaviors in three South African communities. Soc Sci Med. 2006;62(7):1641–9.

    Article  PubMed  Google Scholar 

  29. Pearlin LI, Schieman S, Fazio EM, Meersman SC. Stress, health, and the life course: some conceptual perspectives. J Health Soc Behav. 2005;46(2):205–19.

    Article  PubMed  Google Scholar 

  30. Bouhnik AD, Chesney M, Carrieri P, Gallais H, Moreau J, Moatti JP, et al. Nonadherence among HIV-infected injecting drug users: the impact of social instability. J Acquir Immune Defic Syndr. 2002;31(SUPPL. 3):S149–53.

    PubMed  Google Scholar 

  31. Gibbs LE. A classification of alcoholics relevant to type-specific treatment. Int J Addict. 1980;15(4):461–88.

    PubMed  CAS  Google Scholar 

  32. Elbogen EB, Swanson JW, Swartz MS, Van Dorn R. Medication nonadherence and substance abuse in psychotic disorders: impact of depressive symptoms and social stability. J Nerv Ment Dis. 2005;193(10):673–9.

    Article  PubMed  Google Scholar 

  33. McGuire JF, Rosenheck RA. Criminal history as a prognostic indicator in the treatment of homeless people with severe mental illness. Psychol Serv. 2004;55(1):42–8.

    Article  Google Scholar 

  34. Gory ML, Ritchey FJ, Mullis J. Depression among the homeless. J Health Soc Behav. 1990;31(1):87–102.

    Article  PubMed  Google Scholar 

  35. Zlotnick C, Robertson MJ, Lahiff M. Getting off the streets: economic resources and residential exits from homelessness. J Commun Psychol. 1999;27(2):209–24.

    Article  Google Scholar 

  36. Tomas A, Dittmar H. The experience of homeless women: an exploration of housing histories and the meaning of home. Hous Stud. 1995;10:493–515.

    Article  Google Scholar 

  37. Weitzman B, Knickman J, Shinn M. Pathways to homelessness among New York City families. J Soc Issues. 2010;46:125–40.

    Article  Google Scholar 

  38. Gebo KA, Keruly J, Moore RD. Association of social stress, illicit drug use, and health beliefs with nonadherence to antiretroviral therapy. J Gen Intern Med. 2003;18(2):104–11.

    Article  PubMed  Google Scholar 

  39. Welte J, Hynes G, Sokolow L, Lyons JP. Effect of length of stay in inpatient alcoholism treatment on outcome. J Stud Alcohol. 1981;42(5):483–91.

    PubMed  CAS  Google Scholar 

  40. Sheldon CT, Aubry TD, Arboleda-Florez J, Wasylenki D, Goering PN. Social disadvantage, mental illness and predictors of legal involvement. Int J Law Psychiatry. 2006;29(3):249–56.

    Article  PubMed  CAS  Google Scholar 

  41. Magdol L. Is moving gendered? The effects of residential mobility on the psychological well-being of men and women. Sex Roles. 2002;47:553–60.

    Article  Google Scholar 

  42. Wistanley A, Thorns DC, Perkins HV. Moving house, creating home: exploring residential mobility. Hous Stud. 2002;17:813–32.

    Article  Google Scholar 

  43. German D, Davey-Rothwell MA, Latkin CA. Residential transience and HIV risk behavior among injection drug users. AIDS Behav. 2007;11(6 Suppl):21–30.

    Article  PubMed  Google Scholar 

  44. Ware NC, Wyatt MA, Tugenberg T. Adherence, stereotyping and unequal HIV treatment for active users of illegal drugs. Soc Sci Med. 2005;61(3):565–76.

    Article  PubMed  Google Scholar 

  45. House JS, Umberson D, Landis KR. Structural and processes of social support. Annu Rev Sociol. 1988;14:293–318.

    Article  Google Scholar 

  46. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.

    Article  Google Scholar 

  47. Wolitski RJ, Kidder DP, Fenton KA. HIV, homelessness, and public health: critical issues and a call for increased action. AIDS Behav. 2007;11(6 Suppl):167–71.

    Article  PubMed  Google Scholar 

  48. Aidala A, Cross JE, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: implications for prevention and policy. AIDS Behav. 2005;9(3):251–65.

    Article  PubMed  Google Scholar 

  49. Miller M, Neaigus A. An economy of risk: resource acquisition strategies of inner city women who use drugs. Int J Drug Policy. 2002;13(5):409–18.

    Article  CAS  Google Scholar 

  50. Gillespie S, Kadiyala S, Greener R. Is poverty or wealth driving HIV transmission? AIDS. 2007;21(SUPPL. 7):S5–16.

    Article  PubMed  Google Scholar 

  51. Blankenship KM, Smoyer AB, Bray SJ, Mattocks K. Black-white disparities in HIV/AIDS: the role of drug policy and the corrections system. J Health Care Poor Underserved. 2005;16(4 Suppl B):140–56.

    Article  PubMed  Google Scholar 

  52. Wohl DA, Rosen D, Kaplan AH. HIV and incarceration: dual epidemics. The AIDS Reader 2006;16(5):247–50, 257.

  53. Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42.

    Article  PubMed  Google Scholar 

  54. Choi KH, Binson D, Adelson M, Catania JA. Sexual harassment, sexual coercion, and HIV risk among U.S. adults 18–49 years. AIDS Behav. 1998;2(1):33–40.

    Article  Google Scholar 

  55. DiIorio C, Dudley WN, Soet J, Watkins J, Maibach E. A social cognitive-based model for condom use among college students. Nurs Res. 2000;49(4):208–14.

    Article  Google Scholar 

  56. Auerbach JD, Coates TJ. HIV prevention research: accomplishments and challenges for the third decade of AIDS. Am J Public Health. 2000;90(7):1029–32.

    Article  PubMed  CAS  Google Scholar 

  57. Piot P, Bartos M, Larson H, Zewdie D, Mane P. Coming to terms with complexity: a call to action for HIV prevention. Lancet. 2008;372(9641):845–59.

    Article  PubMed  Google Scholar 

  58. Des Jarlais D, Abdul-Quader A, Tross S. The next problem: maintenance of AIDS risk reduction among intravenous drug users. Int J Addict. 1991;26(12):1279–92.

    PubMed  CAS  Google Scholar 

  59. Oakley A, Fullerton D, Holland J. Behavioral interventions for HIV/AIDS prevention. AIDS. 1995;9(5):479–86.

    PubMed  CAS  Google Scholar 

  60. Rhodes T, Stimson G, Quirk A. Sex, drugs, intervention and research: from the individual to the social. Subst Use Misuse. 1996;31(3):375–407.

    Article  PubMed  CAS  Google Scholar 

  61. Auerbach J, Wypijewska C, Brodie H, Hammond K, editors. Institute of Medicine. AIDS and behavior: an integrated approach. 1994. Washington, DC, National Academy Press.

  62. Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav 1995;Spec No: 80–94.

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Acknowledgments

The National Institute of Mental Health provided financial support (grants R01 MH066810 and F31 MH073430). The authors also wish to thank the study participants and Lighthouse team and acknowledge the contributions of David R. Holtgrave, David D. Celentano, and George W. Rebok.

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  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21215, USA

    Danielle German & Carl A. Latkin

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  1. Danielle German
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Correspondence to Danielle German.

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German, D., Latkin, C.A. Social Stability and HIV Risk Behavior: Evaluating the Role of Accumulated Vulnerability. AIDS Behav 16, 168–178 (2012). https://doi.org/10.1007/s10461-011-9882-5

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