title: Stakeholder conceptualisation of multi-level HIV and AIDS determinants in a Black epicentre.
abstract: HIV has reached epidemic proportions among African Americans in the USA but certain urban contexts appear to experience a disproportionate disease burden. Geographic information systems mapping in Philadelphia indicates increased HIV incidence and prevalence in predominantly Black census tracts, with major differences across adjacent communities. What factors shape these geographic HIV disparities among Black Philadelphians? This descriptive study was designed to refine and validate a conceptual model developed to better understand multi-level determinants of HIV-related risk among Black Philadelphians. We used an expanded ecological approach to elicit reflective perceptions from administrators, direct service providers and community members about individual, social and structural factors that interact to protect against or increase the risk for acquiring HIV within their community. Gender equity, social capital and positive cultural mores (e.g., monogamy, abstinence) were seen as the main protective factors. Historical negative contributory influences of racial residential segregation, poverty and incarceration were among the most salient risk factors. This study was a critical next step toward initiating theory-based, multi-level community-based HIV prevention initiatives.
authors.affiliation: a Department of Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , USA.
authors.forename: Bridgette M
authors.initials: BM
authors.lastname: Brawner
authors.affiliation: a Department of Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , USA.
authors.forename: Janaiya L
authors.initials: JL
authors.lastname: Reason
authors.affiliation: a Department of Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , USA.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Hanlon
authors.affiliation: b Department of Nursing , Northeastern University , Boston , USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Guthrie
authors.affiliation: c Department of Implementation Science , Institute for Community Research , Hartford , USA.
authors.forename: Jean J
authors.initials: JJ
authors.lastname: Schensul
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology*; D000328:Adult; D001741:Black or African American / Q000208:ethnology / Q000523:psychology*; D001294:Attitude to Health / Q000208:ethnology; D003469:Culture; D005260:Female; D017144:Focus Groups; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D011203:Poverty; D012307:Risk Factors; D055815:Young Adult
keywords: AIDS; African Americans; Black; HIV; USA; epidemic determinants; structural factors