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Migration, Neighborhoods, and Networks: Approaches to Understanding How Urban Environmental Conditions Affect Syndemic Adverse Health Outcomes Among Gay, Bisexual and Other Men Who Have Sex with Men

AIDS and Behavior volume 15, pages 35–50 (2011)Cite this article

Abstract

Adopting socioecological, intersectionality, and lifecourse theoretical frameworks may enhance our understanding of the production of syndemic adverse health outcomes among gay, bisexual and other men who have sex with men (MSM). From this perspective, we present preliminary data from three related studies that suggest ways in which social contexts may influence the health of MSM. The first study, using cross-sectional data, looked at migration of MSM to the gay resort area of South Florida, and found that amount of time lived in the area was associated with risk behaviors and HIV infection. The second study, using qualitative interviews, observed complex interactions between neighborhood-level social environments and individual-level racial and sexual identity among MSM in New York City. The third study, using egocentric network analysis with a sample of African American MSM in Baltimore, found that sexual partners were more likely to be found through face-to-face means than the Internet. They also observed that those who co-resided with a sex partner had larger networks of people to depend on for social and financial support, but had the same size sexual networks as those who did not live with a partner. Overall, these findings suggest the need for further investigation into the role of macro-level social forces on the emotional, behavioral, and physical health of urban MSM.

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Notes

  1. We define “men of color” here as men who self-identify or are identified by society as African American or Black, Latino, Asian or multi-ethnic/race.

References

  1. House JS, Williams DR. Understanding and reducing socioeconomic and racial/ethnic disparities in health. In: Smedley BD, Syme SL, editors. Promoting health: intervention strategies from social and behavioral research. Washington, DC: National Academy Press; 2000.

    Google Scholar 

  2. Woody GE, VanEtten-Lee ML, McKirnan D, et al. Substance use among men who have sex with men: comparison with a national household survey. J Acquir Immune Defic Syndr. 2001;27(1):86–90.

    PubMed  CAS  Google Scholar 

  3. Tang H, Greenwood GL, Cowling DW, et al. Cigarette smoking among lesbians, gays, and bisexuals: how serious a problem? (United States). Cancer Causes Control. 2004;15(8):797–803.

    PubMed  Article  Google Scholar 

  4. Sandfort TG, deKeizer M. Sexual problems in gay men: an overview of empirical research. Annu Rev Sex Res. 2001;12:93–120.

    PubMed  CAS  Google Scholar 

  5. Conron KJ, Mimiaga MJ, Landers SJ. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health. 2010;100(10):1953–60.

    PubMed  Article  Google Scholar 

  6. Stall R, Mills TC, Williamson 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.

    PubMed  Article  Google Scholar 

  7. Wolitski R, Stall R, Valdiserri RO. Unequal opportunity: health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press; 2007.

    Google Scholar 

  8. Frye V, Latka MH, Koblin B, et al. The urban environment and sexual risk behavior among men who have sex with men. J Urban Health. 2006;83(2):308–24.

    PubMed  Article  Google Scholar 

  9. Bronfenbrenner U. The ecology of human development: experiments by nature and design. Cambridge: Harvard University Press; 1979.

    Google Scholar 

  10. Garbarino J. Adolescent development: an ecological perspective. Columbus: Charles E. Merrill Publishing Company; 1985.

    Google Scholar 

  11. Diclemente RJ, Salazar LF, Crosby RA. A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach. J Pediatr Psychol. 2007;32(8):888–906.

    PubMed  Article  Google Scholar 

  12. Diclemente RJ, Salazar LF, Crosby RA, Rosenthal SL. Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective—a commentary. Public Health. 2005;119(9):825–36.

    PubMed  Article  CAS  Google Scholar 

  13. Crenshaw K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Legal Forum. 1989;1989:139.

    Google Scholar 

  14. Staunæs D. Where have all the subjects gone? Bringing together the concepts of intersectionality and subjectification. NORA. 2007;2(11):101–9.

    Google Scholar 

  15. Hancock A. Intersectionality as a normative and empirical paradigm. Politics Gend. 2007;3(2):248–53.

    Google Scholar 

  16. Simien E. Doing intersectionality research: from conceptual issues to practical examples. Politics Gend. 2007;3(2):264–71.

    Google Scholar 

  17. Ben-Shlomo Y, Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int J Epidemiol. 2002;31(2):285–93.

    PubMed  Article  Google Scholar 

  18. Davey Smith G. The uses of ‘Uses of Epidemiology’. Int J Epidemiol. 2001;30:1146–55.

    Article  Google Scholar 

  19. Kramer L. Faggots. New York: First Plume Printing; 1978.

    Google Scholar 

  20. Shilts R. And the band played on. New York: St. Martin’s Press; 1987.

    Google Scholar 

  21. Levine MP. Gay Macho: the life and death of the homosexual clone. New York: New York University Press; 1998.

    Google Scholar 

  22. Mansergh G, Colfax GN, Marks G, et al. The circuit party men’s health survey: findings and implications for gay and bisexual men. Am J Public Health. 2001;91(6):953–8.

    PubMed  Article  CAS  Google Scholar 

  23. Signorile M. The Signorile report on gay men: sex, drugs, and the passages of life. New York: St. Martin’s Press; 1997.

    Google Scholar 

  24. Benotsch EG, Kalichman S, Cage M. Men who have met sex partners via the Internet: prevalence, predictors, and implications for HIV prevention. Arch Sex Behav. 2002;31(2):177–83.

    PubMed  Article  Google Scholar 

  25. Kim AA, Kent C, McFarland W, Klausner JD. Cruising on the Internet highway. J Acquir Immune Defic Syndr. 2002;28(1):89–93.

    CAS  Google Scholar 

  26. Hirshfield S, Remien RH, Humberstone M, Walavalkar I, Chiasson MA. Substance use and high-risk sex among men who have sex with men: a national online study in the USA. AIDS Care. 2004;16(8):1036–47.

    PubMed  Article  CAS  Google Scholar 

  27. Siegel K, Mesagno FP, Chen JY, Christ G. Factors distinguishing homosexual males practicing risky and safer sex. Soc Sci Med. 1989;28(6):561–9.

    PubMed  Article  CAS  Google Scholar 

  28. Centers for Disease Control, Prevention. HIV/AIDS Surveillance Report, 2007, vol. 19. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009.

    Google Scholar 

  29. Holleran A. Dancer from the dance. New York: William Morrow; 1978.

    Google Scholar 

  30. Mills TC, Stall R, Pollack L, et al. Health-related characteristics of men who have sex with men: a comparison of those living in “gay ghettos” with those living elsewhere. Am J Public Health. 2001;91(6):980–3.

    PubMed  Article  CAS  Google Scholar 

  31. Smith DM, Gates GJ. Gay and lesbian families in the United States: same-sex unmarried partner households: a preliminary analysis of 2000 United States Census data, a human rights campaign report. Washington, DC: Human Rights Campaign; 2001.

    Google Scholar 

  32. Centers for Disease Control and Prevention. HIV prevelance, unrecognized infection, and HIV testing among men who have sexs wiht men—five U.S. cities, June 2004–April 2005, MMWR Morbidity and Mortality Weekly Report, 54(24). Atlanta: U.S.: Department of Health and Human Services, Centers for Disease Control and Prevention; 2005.

  33. Kurtz SP. Between Kansas and Oz: drugs, sex, and the search for gay identity in the fast lane. In: Hammack P, Cohler B, editors. Life course and sexual identity: narrative perspective. New York: Oxford University Press; 2009. p. 157–75.

    Google Scholar 

  34. Cochran SD, Mays VM. Estimating prevalence of mental and substance-using disorders among lesbians and gay men from existing national health data. In: Omoto AM, Kurtzman HS, editors. Sexual orientation and mental health. Washington, DC: American Psychological Association; 2006. p. 143–66.

    Google Scholar 

  35. McKirnan D, Houston E, Tolou-Shams M. Is the web the culprit? Cognitive escape and internet sexual risk among gay and bisexual men. AIDS Behav. 2006;11(1):151–60.

    Article  Google Scholar 

  36. Taylor M, Aynalem G, Smith L, et al. Correlates of Internet use to meet sex partners among men who have sex with men diagnosed with early syphilis in Los Angeles County. Sex Transm Dis. 2004;31(9):552–6.

    PubMed  Article  Google Scholar 

  37. Dolezal C, Meyer-Bahlburg HFL, Remien RH, Petkova E. Substance use during sex and sensation seeking as predictors of sexual risk behavior among HIV+ and HIV− gay men. AIDS Behav. 1997;1(1):19–28.

    Article  Google Scholar 

  38. Ostrow DG, DiFranceisco W, Kalichman SC. Sexual adventurism, substance use and sexual behavior: a structural modeling analysis of the Chicago MACS/CCS cohort. AIDS Behav. 2010;1(3):191–202.

    Article  Google Scholar 

  39. Bianchi FT, Reisen CA, Zea MC, et al. The sexual experiences of Latino men who have sex with men who migrated to a gay epicentre in the USA. Cult Health Sex. 2007;9(5):505–18.

    PubMed  Article  Google Scholar 

  40. Green AI, Halkitis PN. Crystal methamphetamine and sexual sociality in an urban gay subculture: an elective affinity. Cult Health Sex. 2006;8(4):317–33.

    PubMed  Article  Google Scholar 

  41. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277(5328):918–24.

    PubMed  Article  CAS  Google Scholar 

  42. Kim D. Blues from the neighborhood? Neighborhood characteristics and depression. Epidemiol Rev. 2008;30:101–17.

    PubMed  Article  CAS  Google Scholar 

  43. Beard JR, Cerda M, Blaney S, et al. Neighborhood characteristics and change in depressive symptoms among older residents of New York City. Am J Public Health. 2009;99(7):1308–14.

    PubMed  Article  Google Scholar 

  44. Cohen DA, Mason K, Bedimo A, et al. Neighborhood physical conditions and health. Am J Public Health. 2003;93(3):467–71.

    PubMed  Article  Google Scholar 

  45. Galea S, Nandi A, Vlahov D. The social epidemiology of substance use. Epidemiol Rev. 2004;26:36–52.

    PubMed  Article  Google Scholar 

  46. Vega WA, Ang A, Rodriguez MA, Finch BK. Neighborhood protective effects on depression in Latinos. Am J Community Psychol. 2010.

  47. Aslund C, Starrin B, Nilsson KW. Social capital in relation to depression, musculoskeletal pain, and psychosomatic symptoms: a cross-sectional study of a large population-based cohort of Swedish adolescents. BMC Public Health. 2010;10:715.

    PubMed  Article  Google Scholar 

  48. Lipperman-Kreda S, Grube JW, Paschall MJ. Community norms, enforcement of minimum legal drinking age laws, personal beliefs and underage drinking: an explanatory model. J Commun Health. 2010;35(3):249–57.

    Article  Google Scholar 

  49. deMause N, Green E. The campaign for fiscal equity lawsuit was the best hope for city schools. It failed. The Village Voice. 2009.

  50. Drucker E. Population impact of mass incarceration under New York’s Rockefeller drug laws: an analysis of years of life lost. J Urban Health. 2002;79(3):434–5.

    PubMed  Google Scholar 

  51. Fagan J, Zimring FE, Kim J. Declining homicide in New York City: a tale of two trends. J Crim Law Criminol. 1998;88:1277–323.

    Article  Google Scholar 

  52. Fagan J. The natural history of neighborhood violence. J Contemp Crim Justice. 2004;20(2):127–47.

    Article  Google Scholar 

  53. Messner SF, Galea S, Tardiff KJ, et al. Policing, drugs, and the homicide decline in New York City in the 1990s. Criminology. 2010;45(2):385–414.

    Article  Google Scholar 

  54. Paying more for the American dream IV: The decline of prime mortgage lending in communities of color. A Joint Report By: California Reinvestment Coalition, Community Reinvestment Association of North Carolina, Empire Justice Center, Massachusetts Affordable Housing Alliance, Neighborhood Economic Development Advocacy Project, Ohio Fair Lending Coalition, Woodstock Institute. May, 2010. Available at: www.nedap.org/resources/reports.html; Accessed 17 Dec 2010.

  55. U.S. Census Bureau. American Fact Finder, Census 2000 Demographic Profile Highlights. 2010.

  56. Wilson M, Baker A. Lured into a trap, then tortured for being gay. New York: The New York Times; 2010.

    Google Scholar 

  57. Frost SD. Using sexual affiliation networks to describe the sexual structure of a population. Sex Transm Infect. 2007;83(Suppl 1):i37–42.

    PubMed  Article  Google Scholar 

  58. Lee SS, Tam DK, Tan Y, et al. An exploratory study on the social and genotypic clustering of HIV infection in men having sex with men. AIDS. 2009;23(13):1755–64.

    PubMed  Article  Google Scholar 

  59. Miller M, Serner M, Wagner M. Sexual diversity among black men who have sex with men in an inner-city community. J Urban Health. 2005;82(1 Suppl 1):i26–34.

    PubMed  Google Scholar 

  60. Friedman SR, Neaigus A, Jose B, et al. Sociometric risk networks and risk for HIV infection. Am J Public Health. 1997;87(8):1289–96.

    PubMed  Article  CAS  Google Scholar 

  61. Perisse AR, Langenberg P, Hungerford L, et al. Egocentric network data provide additional information for characterizing an individual’s HIV risk profile. AIDS. 2010;24(2):291–8.

    PubMed  Article  Google Scholar 

  62. Ward H. Prevention strategies for sexually transmitted infections: importance of sexual network structure and epidemic phase. Sex Transm Infect. 2007;83(Suppl 1):i43–9.

    PubMed  Article  Google Scholar 

  63. Kottiri BJ, Friedman SR, Neaigus A, Curtis R, Des J. Risk networks and racial/ethnic differences in the prevalence of HIV infection among injection drug users. J Acquir Immune Defic Syndr. 2002;30(1):95–104.

    PubMed  Article  Google Scholar 

  64. Knowlton AR. Informal HIV caregiving in a vulnerable population: toward a network resource framework. Soc Sci Med. 2003;56(6):1307–20.

    PubMed  Article  Google Scholar 

  65. Zenilman JM, Ellish N, Fresia A, Glass G. The geography of sexual partnerships in Baltimore: applications of core theory dynamics using a geographic information system. Sex Transm Dis. 1999;26(2):75–81.

    PubMed  Article  CAS  Google Scholar 

  66. Thiede H, Jenkins RA, Carey JW, et al. Determinants of recent HIV infection among Seattle-area men who have sex with men. Am J Public Health. 2009;99(Suppl 1):S157–64.

    PubMed  Google Scholar 

  67. Latkin CA, Mandell W, Vlahov D. The relationship between risk networks’ patterns of crack cocaine and alcohol consumption and HIV-related sexual behaviors among adult injection drug users: a prospective study. Drug Alcohol Depend. 1996;42(3):175–81.

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

The following individuals contributed to the design and/or conduct of the parent studies described here, including: STUDY #1: James Inciardi, Ron Stall, Hilary L. Surratt, Gustavo Aguilera, Douglas Maesk, Matthew Bradley, Mance Buttram, John Crane, Luis DeJesus, Manh Nguyen, and Christopher Stults (Miami). This study was support by Grant Number R01DA024579 from the National Institute on Drug Abuse. STUDY #2: John Beard, Magdalena Cerda, Sandro Galea, Mary H. Latka, Hong Van Tieu and David Vlahov (New York City). This study was supported by grant number R01 HD059729 from the National Institute of Child Health and Human Development. STUDY #3: Melissa Davey-Rothwell, Joanne Jenkins, Errol Fields, Tia Zeno, Danielle German (Baltimore). The LAAMP Study Team also wishes to acknowledge all of the study participants who volunteered for this project and the study staff and facilitators for their commitment to the success of this project. We would like to acknowledge and thank the CDC Study Team: Pilgrim Spikes, Jocelyn Patterson, Stephen A. Flores, Heather Joseph, David Purcell, Greg Millett, Cathy Zhang, and Helen Ding. This study was supported by a cooperative agreement between Johns Hopkins University and the Centers for Disease Control and Prevention (1 UR6 PS000355-01). Finally, we would like to thank Hilary Goldhammer for her assistance in the editing and preparation of this manuscript.

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Affiliations

  1. Center for Urban Epidemiologic Studies, The New York Academy of Medicine, New York, NY, USA

    James E. Egan

  2. Laboratory of Social and Behavioral Sciences, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA

    Victoria Frye

  3. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    Victoria Frye

  4. Division of Applied Interdisciplinary Studies, Nova Southeastern University, Coral Gables, FL, USA

    Steven P. Kurtz & Minxing Chen

  5. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

    Carl Latkin, Karin Tobin & Cui Yang

  6. Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA

    Beryl A. Koblin

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  1. James E. Egan
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  2. Victoria Frye
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  3. Steven P. Kurtz
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Correspondence to Victoria Frye.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institutes of Health or the Centers for Disease Control and Prevention.

Author Contributions: Authors of each study are listed as footnotes in each section.

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Egan, J.E., Frye, V., Kurtz, S.P. et al. Migration, Neighborhoods, and Networks: Approaches to Understanding How Urban Environmental Conditions Affect Syndemic Adverse Health Outcomes Among Gay, Bisexual and Other Men Who Have Sex with Men. AIDS Behav 15, 35–50 (2011). https://doi.org/10.1007/s10461-011-9902-5

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Keywords

  • Homosexuality
  • Male
  • Urban health
  • Social environment