Featured Research

from universities, journals, and other organizations

HIV battle must focus on hard-hit streets, paper argues

Date:
April 10, 2014
Source:
Brown University
Summary:
When it comes to HIV, geography can be destiny, argue authors of a new article. The epidemic has become heavily concentrated in poor urban neighborhoods where people are less likely to be tested and treated, creating more risk that the virus will spread. New prevention efforts should focus on neighborhoods.

“Do One Thing” – get tested. Knowing one’s HIV and hepatitis C status is a significant step toward treatment and controlling the spread of disease. Door-to-door efforts like Philadelphia’s “Do One Thing” help, but more resources for testing and treatment need to target communities that need them most.
Credit: Image courtesy of Brown University

In U.S. cities, it's not just what you do, but also your address that can determine whether you will get HIV and whether you will survive. A new paper in the American Journal of Public Health illustrates the effects of that geographic disparity -- which tracks closely with race and poverty -- and calls for an increase in geographically targeted prevention and treatment efforts.

"People of color are disproportionately impacted, and their risk of infection is a function not just of behavior but of where they live and the testing and treatment resources in their communities," said lead author Amy Nunn, assistant professor (research) of behavioral and social sciences in the Brown University School of Public Health. "Limited health services mean more people who don't know their HIV status and who are not on treatment. People who don't have access to treatment are much more likely to infect others. Simply having more people in your sexual network with uncontrolled HIV infection raises the probability that you will come into contact with the virus. This is not just about behavior, this is about access to critical health services."

It's no secret that the United States has economic disparities in access to health care, but the consequences of that for the HIV epidemic are laid bare in maps in the paper. They show that the nation's epidemic has become concentrated in urban minority neighborhoods, where HIV incidence can be comparable to some countries of sub-Saharan Africa.

The high-incidence minority neighborhoods of New York and Philadelphia, the maps show, have a high death rate as well, even compared to simlarly high-incidence neighborhoods that are wealthier and whiter. The most likely difference between the communities, Nunn said, is in their access to testing, treatment, and care services.

Nunn and co-authors including Phill Wilson, president and CEO of the Black AIDS Institute, said federal and state public health efforts should recognize that geography contributes to HIV risk and focus greater efforts on targeting the most heavily impacted neighborhoods around the country. Instead, there has been less federal money for interventions outside of clinical settings.

"With the new surveillance tools available to us, we know where the epidemic is down to the census track or zip code," Wilson said. "If we are serious about ending the AIDS epidemic in this country, we need to use those tools to invest in vulnerable communities. Unfortunately, instead of building infrastructure and expanding capacity in poor urban communities, we are dismantling the fragile infrastructure that exists."

Early efforts

Aware of the need, many of the paper's authors have helped put together neighborhood testing and treatment campaigns in recent years. The projects provide templates, they say, for engaging local communities through grassroots action and partnership with local institutions and media. These not only spread the word, but also reduce the stigma of openly confronting the disease. The authors also argue for a research and policy agenda that focuses on neighborhoods rather than solely on individuals for HIV intervention strategies.

An especially large effort, "The Bronx Knows," led by the New York City Department of Health, brought together 75 local institutions and other partners between 2008 and 2011 to cover the entire New York City borough. The campaign, in part led by co-author Dr. Blayne Cutler, conducted more than 600,000 tests and confirmed 4,800 cases, including 1,700 that weren't previously known. The percentage of local adults who reported having been tested rose to 80 percent from 72 percent and HIV positive residents linked to appropriate health care rose to 84 percent from 82 percent.

Since 2012 Nunn has led a privately funded project focused on Philadelphia's 19143 zip code, one of the most heavily impacted neighborhoods of the country, called "Do One Thing." Working with colleagues including co-author Dr. Stacey Trooskin of Drexel University, Do One Thing has partnered with local media and leaders including clergy, and sent volunteers door-to-door to promote HIV and HCV testing and treatment.

So far Nunn's teams have tested more than 6,000 residents with an HIV rate of 0.7 percent. They simultaneously test for hepatitis C and have found that 5 percent of those who test are HCV positive. When people test positive for either virus, the teams immediately link them to health services and treatment.

Targeting testing and treatment

Other efforts of varying nature and scale are underway in San Diego, Oakland, Washington D.C., and Miami, but in the article the authors report that such campaigns are not yet enough to turn every tide that has flooded neighborhoods around the country with especially high degrees of infection and mortality.

More of the money granted to states and cities, for instance, could be targeted to the neighborhoods with highest infection rates and where testing and treatment have been most lacking.

"Many of our resources don't go to the communities who need them most," Nunn said. "But we know exactly where people live who are becoming infected. We have so many tools that we know are effective at fighting the epidemic. Not to provide them to the most heavily impacted communities is a social injustice. We should be rolling out testing and treatment services and positive social marketing messages en masse in these communities."


Story Source:

The above story is based on materials provided by Brown University. Note: Materials may be edited for content and length.


Journal Reference:

  1. Amy Nunn, Annajane Yolken, Blayne Cutler, Stacey Trooskin, Phill Wilson, Susan Little, Kenneth Mayer. Geography Should Not Be Destiny: Focusing HIV/AIDS Implementation Research and Programs on Microepidemics in US Neighborhoods. American Journal of Public Health, 2014; 104 (5): 775 DOI: 10.2105/AJPH.2013.301864

Cite This Page:

Brown University. "HIV battle must focus on hard-hit streets, paper argues." ScienceDaily. ScienceDaily, 10 April 2014. <www.sciencedaily.com/releases/2014/04/140410095639.htm>.
Brown University. (2014, April 10). HIV battle must focus on hard-hit streets, paper argues. ScienceDaily. Retrieved September 1, 2014 from www.sciencedaily.com/releases/2014/04/140410095639.htm
Brown University. "HIV battle must focus on hard-hit streets, paper argues." ScienceDaily. www.sciencedaily.com/releases/2014/04/140410095639.htm (accessed September 1, 2014).

Share This




More Health & Medicine News

Monday, September 1, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Get on Your Bike! London Cycling Popularity Soars Despite Danger

Get on Your Bike! London Cycling Popularity Soars Despite Danger

AFP (Sep. 1, 2014) Wedged between buses, lorries and cars, cycling in London isn't for the faint hearted. Nevertheless the number of people choosing to bike in the British capital has doubled over the past 15 years. Duration: 02:27 Video provided by AFP
Powered by NewsLook.com
Can You Train Your Brain To Eat Healthy?

Can You Train Your Brain To Eat Healthy?

Newsy (Sep. 1, 2014) New research says if you condition yourself to eat healthy foods, eventually you'll crave them instead of junk food. Video provided by Newsy
Powered by NewsLook.com
We've Got Mites Living In Our Faces And So Do You

We've Got Mites Living In Our Faces And So Do You

Newsy (Aug. 30, 2014) A new study suggests 100 percent of adult humans (those over 18 years of age) have Demodex mites living in their faces. Video provided by Newsy
Powered by NewsLook.com
Liberia Continues Fight Against Ebola

Liberia Continues Fight Against Ebola

AFP (Aug. 30, 2014) Authorities in Liberia try to stem the spread of the Ebola epidemic by raising awareness and setting up sanitation units for people to wash their hands. Duration: 00:41 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins