Multilevel drivers of human immunodeficiency virus/acquired immune deficiency syndrome among Black Philadelphians: exploration using community ethnography and geographic information systems.
BACKGROUND
Unequal human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) distribution is influenced by certain social and structural contexts that facilitate HIV transmission and concentrate HIV in disease epicenters. Thus, one of the first steps in designing effective community-level HIV/AIDS initiatives is to disentangle the influence of individual, social, and structural factors on HIV risk. Combining ethnographic methodology with geographic information systems mapping can allow for a complex exploration of multilevel factors within communities that facilitate HIV transmission in highly affected areas.


OBJECTIVE
We present the formative comparative community-based case study findings of an investigation of individual-, social-, and structural-level factors that contribute to the HIV/AIDS epidemic among Black Philadelphians.


METHODS
Communities were defined using census tracts. The methodology included ethnographic and geographic information systems mapping, observation, informal conversations with residents and business owners, and secondary analyses of census tract-level data in four Philadelphia neighborhoods.


RESULTS
Factors such as overcrowding, disadvantage, permeability in community boundaries, and availability and accessibility of health-related resources varied significantly. Furthermore, HIV/AIDS trended with social and structural inequities above and beyond the community's racial composition.


CONCLUSIONS
This study was a first step to disentangle relationships between community-level factors and potential risk for HIV in an HIV epicenter. The findings also highlight stark sociodemographic differences within and across racial groups and further substantiate the need for comprehensive, community-level HIV prevention interventions. These findings from targeted U.S. urban communities have potential applicability for examining the distribution of HIV/AIDS in broader national and international geosocial contexts.
Bridgette M. Brawner, PhD, APRN, is Assistant Professor of Nursing; and Janaiya L. Reason, BS, is Research Administrative Coordinator, Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia. Bridget A. Goodman, PhD, is Assistant Professor, Graduate School of Education, Nazarbayev University, Astana, Kazakhstan. Jean J. Schensul, PhD, is Senior Scientist and Founder, Institute for Community Research, Hartford, Connecticut. Barbara Guthrie, PhD, RN, FAAN, is Professor and Director of the Nursing PhD Program, Northeastern University, Boston, Massachusetts.
Bridgette M
BM
Brawner
Janaiya L
JL
Reason
Bridget A
BA
Goodman
Jean J
JJ
Schensul
Barbara
B
Guthrie
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000884:Anthropology, Cultural; D003710:Demography; D004779:Environment Design; D058872:Epidemics; D005260:Female; D040362:Geographic Information Systems; D015658:HIV Infections / Q000208:ethnology*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D012959:Socioeconomic Factors