AIDS and Behavior

, Volume 19, Issue 12, pp 2358–2369 | Cite as

Where You Live Matters: Structural Correlates of HIV Risk Behavior Among Young Men Who Have Sex with Men in Metro Detroit

  • José A. BauermeisterEmail author
  • Lisa Eaton
  • Jack Andrzejewski
  • Jimena Loveluck
  • William VanHemert
  • Emily S. Pingel
Original Paper


Structural characteristics are linked to HIV/STI risks, yet few studies have examined the mechanisms through which structural characteristics influence the HIV/STI risk of young men who have sex with men (YMSM). Using data from a cross-sectional survey of YMSM (ages 18–29) living in Detroit Metro (N = 328; 9 % HIV-positive; 49 % Black, 27 % White, 15 % Latino, 9 % Other race), we used multilevel modeling to examine the association between community-level characteristics (e.g., socioeconomic disadvantage; distance to LGBT-affirming institutions) and YMSM’s HIV testing behavior and likelihood of engaging in unprotected anal intercourse with serodiscordant partner(s). We accounted for individual-level factors (race/ethnicity, poverty, homelessness, alcohol and marijuana use) and contextual factors (community acceptance and stigma regarding same-sex sexuality). YMSM in neighborhoods with greater disadvantage and nearer to an AIDS Service Organization were more likely to have tested for HIV and less likely to report serodiscordant partners. Community acceptance was associated with having tested for HIV. Efforts to address YMSM’s exposure to structural barriers in Detroit Metro are needed to inform HIV prevention strategies from a socioecological perspective.


Social determinants Neighborhoods Socioeconomic disadvantage Testing 


Las características estructurales están asociadas a los riesgos de VIH/ETS; sin embargo, pocos estudios han examinado qué mecanismos influyen en las conductas de riesgo de VIH/ETS de los hombres jóvenes que tienen sexo con hombres (YMSM). Utilizando datos de una encuesta de YMSM (edades 18-29) que viven en el área metropolitana de Detroit (N = 328; 9 % VIH positivo; 49 % Negro, 27 % blancos, 15 % latinos, 9 % Otros raza), utilizamos un modelo multinivel para examinar la asociación entre las características a nivel comunitario (por ejemplo, la desventaja socioeconómica, la distancia a las instituciones LGBT afirman) y dos conducta: el testeo de VIH y la probabilidad de tener relaciones anales sin protección con pareja(s) serodiscordante(s). Incluimos factores individuales (raza/etnia, pobreza, falta de vivienda, uso de alcohol y marihuana) y contextuales (aceptación y estigma comunitario respecto a la sexualidad del mismo sexo). YMSM que viven en barrios con mayor desventaja socioeconómica y con más cercanía a organizaciones que proveen servicios de VIH/SIDA fueron más propensos a haber testeado y menos propensos a reportar relaciones sexuales con parejas serodiscordantes. Aceptación comunitaria se asoció con una mayor probabilidad de haber testeado. Esfuerzos para hacer frente a las barreras estructurales en Detroit son necesarias para elucidar el desarrollo de estrategias de prevención del VIH desde una perspectiva socio-ecológica.



The United for HIV Integration and Policy (UHIP) academic-community partnership included representatives from AIDS Partnership Michigan, the HIV/AIDS Resource Center, Detroit Latin@z, Ruth Ellis Center, and the University of Michigan’s Center for Sexuality & Health Disparities. This work was supported by the MAC AIDS Fund (PI: Bauermeister) and a grant from the Centers for Disease Control and Prevention to Dr. Bauermeister (U22 PS004520). Dr. Eaton was supported by two National Institutes of Health projects (R01MH094230; R01NR013865). The content is solely the responsibility of the authors and does not represent the official views of the funding agencies.


  1. 1.
    Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20:1447–50.CrossRefPubMedGoogle Scholar
  2. 2.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. JAIDS. 2005;39:446–53.PubMedGoogle Scholar
  3. 3.
    Colfax GN, Buchbinder SP, Cornelisse PG, Vittinghoff E, Mayer K, Celum C. Sexual risk behaviors and implications for secondary HIV transmission during and after HIV seroconversion. AIDS. 2002;16:1529–35.CrossRefPubMedGoogle Scholar
  4. 4.
    The U.S. White House. National HIV/AIDS Strategy for the United States. Washington: White House; 2010.Google Scholar
  5. 5.
    Auerbach JD, Parkhurst JO, Caceres CF. Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological considerations. Glob Public Health. 2011;6:S293–309.CrossRefPubMedGoogle Scholar
  6. 6.
    Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008;372:764–75.CrossRefPubMedGoogle Scholar
  7. 7.
    Michigan Department of Community Health. Annual HIV Surveillance Report for Michigan; 2014.Google Scholar
  8. 8.
    Farley R, Danzinger S, Holzer HJ. The evolution of racial segregation Detroit Divided. New York: Russell Sage Foundation; 2000. p. 144–77.Google Scholar
  9. 9.
    Rosenberg ES, Millett GA, Sullivan PS, del Rio C, Curran JW. Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modelling study. Lancet. 2014;1:e112–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Millett GA, Peterson JL, Flores SA, Hart TA, Jeffries WL, Wilson PA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380:341–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Arnold M, Hsu L, Pipkin S, McFarland W, Rutherford GW. Race, place and AIDS: the role of socioeconomic context on racial disparities in treatment and survival in San Francisco. Soc Sci Med. 2009;69:121–8.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Blankenship KM, et al. Structural interventions: concepts, challenges and opportunities for research. J Urban Health. 2006;83:59–72.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Bowleg L, Raj A. Shared communities, structural contexts, and HIV risk: prioritizing the HIV risk and prevention needs of black heterosexual men. Am J Public Health. 2012;102:S173–7.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Sumartojo E. Structural factors in HIV prevention: concepts, examples, and implications for research. AIDS. 2000;14:S3–10.CrossRefPubMedGoogle Scholar
  15. 15.
    Egan JE, Frye V, Kurtz SP, Latkin C, Chen M, Tobin K, 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. 2011;15:35–50.CrossRefGoogle Scholar
  16. 16.
    Frye V, Latka MH, Koblin B, Halkitis PN, Putnam S, Galea S, Vlahov D. The urban environment and sexual risk behavior among men who have sex with men. J Urban Health. 2006;83:308–24.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Cubbin C, Santelli J, Brindis CD, Braveman P. Neighborhood context and sexual behaviors among adolescents: findings from the national longitudinal study of adolescent health. Perspect Sex Reprod Health. 2005;37:125–34.CrossRefPubMedGoogle Scholar
  18. 18.
    Browning CR, Burrington LA, Leventhal T, Brooks-Gunn J. Neighborhood structural inequality, collective efficacy, and sexual risk behavior among urban youth. J Health Soc Behav. 2008;49:269–85.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Kerrigan D, Witt S, Glass B, Chung SE, Ellen J. Perceived neighborhood social cohesion and condom use among adolescents vulnerable to HIV/STI. AIDS Beh. 2006;10:723–9.CrossRefGoogle Scholar
  20. 20.
    Latkin CA, German D, Vlahov D, Galea S. Neighborhoods and HIV: a social ecological approach to prevention and care. Am Psychol. 2013;68:210–24.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Bauermeister JA, Elkington KS, Huebner D. Sexuality and HIV/AIDS prevention. In: Tolman DL, Diamond LM, Bauermeister JA, George WH, Pfaus JG, Ward LM, editors. APA handbook of sexuality and psychology. Washington: APA; 2014. p. 697–724.Google Scholar
  22. 22.
    Goodman RM, Speers MA, McLeroy K, Fawcett S, Kegler M, Parker E, Smith SR, Sterling TD, Wallerstein N. Identifying and defining the dimensions of community capacity to provide a basis for measurement. Health Educ Behav. 1998;25:258–78.CrossRefPubMedGoogle Scholar
  23. 23.
    Kawachi I. Social cohesion and health. In: Tarlov AR, St. Peter RF, editors. The society and population health reader a state and community perspective. The New Press: New York; 2000. p. 57–74.Google Scholar
  24. 24.
    Ramirez-Valles J. The protective effects of community involvement for HIV risk behavior: a conceptual framework. Health Educ Res. 2002;17:389–403.CrossRefPubMedGoogle Scholar
  25. 25.
    Frye V, Koblin B, Chin J, Beard J, Blaney S, Halkitis P, et al. Neighborhood-level correlates of consistent condom use among men who have sex with men: a multi-level analysis. AIDS Behav. 2010;14:974–85.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Buttram ME, Kurtz SE. Risk and protective factors associated with gay neighborhood residence. Am J Mens Health. 2013;7:110–8.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Mills TC, Stall R, Pollack L, Paul JP, Binson D, Canchola J, Catania JA. 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;91:980–3.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Bauermeister JA, Tross S, Ehrhardt AA. A review of HIV/AIDS system-level interventions. AIDS Behav. 2009;13:430–48.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior : a meta-analytic review. Am J Public Health. 1999;89:1397–405.PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Law DCG, Serre ML, Christakos G, Leone PA, Miller WC. Spatial analysis and mapping of sexually transmitted diseases to optimise intervention and prevention strategies. Sex Transm Infect. 2004;80:294–9.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Scribner RA, Johnson SA, Cohen DA, Robinson W, Farley TA, Gruenewald P. Geospatial methods for identification of core groups for HIV/AIDS. Subst Use Misuse. 2008;43:203–21.PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Geanuracos CG, Cunningham SD, Weiss G, Forte D, Reid LMH, Ellen JM. Use of geographic information systems for planning HIV prevention interventions for high-risk youths. Am J Public Health. 2007;97:1974–81.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Leibowitz A, Taylor SL. Distance to public test sites and HIV testing. Med Care Res Rev. 2007;64:568–84.CrossRefPubMedGoogle Scholar
  34. 34.
    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;26:75–81.CrossRefPubMedGoogle Scholar
  35. 35.
    Bauermeister JA, Meanley S, Hickok A, Pingel E, Vanhemert W, Loveluck J. Sexuality-related work discrimination and its association with the health of sexual minority emerging and young adult men in the Detroit Metro Area. Sex Res Soc Policy. 2014;11:1–10.CrossRefGoogle Scholar
  36. 36.
    Bauermeister JA, Pingel E, Zimmerman M, Couper M, Carballo-Dieguez A, Strecher VJ. Data quality in HIV/AIDS web-based surveys: handling invalid and suspicious data. Field Method. 2012;24:272–91.CrossRefGoogle Scholar
  37. 37.
    Teitcher JE, Bockting WO, Bauermeister JA, Hoefer CJ, Miner MH, Klitzman RL. Detecting, preventing, and responding to “fraudsters” in Internet research: ethics and tradeoffs. J Law Med Ethics. 2015;43:116–33.CrossRefPubMedGoogle Scholar
  38. 38.
    Carballo-Diéguez A, Dolezal C, Ventuneac A. Sexual practices assessment schedule. New York: HIV Center for Clinical and Behavioral Studies, Columbia University & New York State Psychiatric Institute; 2002.Google Scholar
  39. 39.
    Kidder DP, Wolitski RJ, Royal S, Aidala A, Courtenay-Quirk C, Holtgrave DR, et al. Access to housing as a structural intervention for homeless and unstably housed people living with HIV: rationale, methods, and implementation of the housing and health study. AIDS Behav. 2007;11:149–61.CrossRefPubMedGoogle Scholar
  40. 40.
    ESRI. ArcGIS desktop. Redlands: Environmental Systems Research Institute; 2011.Google Scholar
  41. 41.
    Herek GM, Glunt EK. Identity and community among gay and bisexual men in the AIDS era: preliminary findings from the Sacramento men’s health study. In: Herek GM, Greene B, editors. AIDS, identity, and community: psychological perspectives on the HIV epidemic and lesbians and gay men. Sage: Newbury Park; 1995. p. 55–84.CrossRefGoogle Scholar
  42. 42.
    Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277:918–24.CrossRefPubMedGoogle Scholar
  43. 43.
    Raudenbush A, Bryk A, Congdon R. HLM 7 for windows. Lincolnwood: Scientific Software International, Inc.; 2011.Google Scholar
  44. 44.
    Raudenbush SW, Bryk A. Hierarchical linear models: applications and data analysis methods. Thousand Oaks: Sage Publications; 2002.Google Scholar
  45. 45.
    Bauermeister JA, Zimmerman MA, Caldwell CH. Neighborhood disadvantage and changes in condom use among African American adolescents. J Urban Health. 2011;88:66–83.PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Johns MM, Bauermeister JA, Zimmerman MA. Individual and neighborhood correlates of HIV testing among African American youth transitioning from adolescence into young adulthood. AIDS Educ Prev. 2010;22:509–22.PubMedCentralCrossRefPubMedGoogle Scholar
  47. 47.
    Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health. 2010;100:590–5.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies. Addiction. 2012;107:51–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Farley R, Danzinger S, Holzer HJ. The persistence of residential segregation. Detroit Divid. New York: Russell Sage Foundation; 2000.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • José A. Bauermeister
    • 1
    Email author
  • Lisa Eaton
    • 2
  • Jack Andrzejewski
    • 1
  • Jimena Loveluck
    • 3
  • William VanHemert
    • 4
  • Emily S. Pingel
    • 1
  1. 1.Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.University of ConnecticutStorrsUSA
  3. 3.HIV/AIDS Resource CenterYpsilantiUSA
  4. 4.AIDS Partnership MichiganDetroitUSA

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