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With Viral Suppression, Study Says Place Matters

Do neighborhood characteristics affect the health of gay and bisexual men living with HIV?

Evidence from a growing number of studies suggests that local social and economic factors, such as living in a high-poverty neighborhood, reduce the likelihood of reaching HIV viral suppression. Clinicians look at viral load – the amount of HIV genetic material in one’s blood – to assess how well HIV treatment is working to reduce the amount of virus in the patient’s body.

The discovery that HIV-positive people in low-income neighborhoods are less likely to achieve viral suppression suggests that something about these places may impede the progression of HIV treatment. To investigate the potential factors that might explain place-based differences in viral suppression in this population, scientists recently measured a range of neighborhood characteristics, from healthcare access to “stop and frisk” rates, in all 42 health districts in New York City.

The study, published in June in AIDS and Behavior, used data from the New York City Department of Health and Mental Hygiene (NYC DOHMH) to compare viral suppression rates among recently diagnosed men who have sex with men across all of the city’s health districts. Using Centers for Disease Control cut-offs, the NYC DOHMH classified men with a viral load below 200 copies/mL as “virally suppressed.” Men who were found to show viral suppression on multiple tests were classified as “durably virally suppressed.”

Of the 7,159 gay and bisexual men in NYC who were diagnosed with HIV between 2009 and 2013, 57% achieved viral suppression in the first 12 months of antiretroviral treatment. Still, only about 37% of this population was classified as durably virally suppressed.

Regarding neighborhood characteristics, gay and bisexual men living in a health district with a low rate of “male couple headed households” were 11% less likely, on average, to achieve viral suppression compared to those living in districts with a high rate of such households. The disparity was even greater among black men, who were 18% less likely to achieve durable viral suppression in districts with low rates of male-male headed households. Gay and bisexual men living in districts where less than 30% of the population identifies as Black were between 11 –14% more likely to achieve viral suppression than those living in districts where over 30% of residents identify as Black.

Dr. Kevin Jefferson, the paper’s first author, studies how discrimination affects health. He is interested in the ways in which intersectional efforts to improve environmental and racial justice can be used to reduce health disparities.

Future research is needed, said Jefferson, to determine exactly how the percentage of gay or bisexual households in a neighborhood or its percentage of Black residents leads to community-wide changes in viral suppression. One potential explanation for the study’s findings is that communities with few gay/bisexual led households and/or many people identifying as Black may have fewer HIV treatment resources coming from outside the community. If this hypothesis were found to be true, there may be evidence to fund public health programs that intentionally reduce these barriers to access.

“The practical applications for public health programming,” noted Jefferson, “are that programs and services might consider a two-pronged approach: (1) bringing in resources to a community and (2) partnering with communities with the specific intent of recognizing and giving them ownership over intra-community programs and services.”

One potential limitation to the study is that residents of a particular health district may spend much of their time in other health districts, but the study did not measure such excursions or their effects of health outcomes. Future longitudinal research is needed to consider the long-term effects of neighborhood residence on HIV treatment.