A Systematic Review of Neighborhood-Level Influences on HIV Vulnerability

Area of Science:

• Public Health
• Social Epidemiology
• Health Equity

Background:

• Understanding social-structural factors is vital for ending the HIV epidemic by 2030.
• Neighborhoods significantly influence HIV outcomes, necessitating research synthesis.
• Existing research highlights the link between neighborhood characteristics and HIV vulnerability.

Purpose of the Study:

• To systematically review the relationship between neighborhood-level factors and HIV vulnerability.
• To examine how neighborhood poverty and disadvantage correlate with sexual behaviors and substance use.
• To map the geographic distribution of studies in relation to high HIV prevalence areas.

Main Methods:

• Systematic review of 55 articles published between 2007 and 2017.
• Searched six electronic databases (PROSPERO CRD42018084384).
• Mapped study locations against high HIV incidence/prevalence areas and the "Ending the HIV Epidemic" initiative.

Main Results:

• Neighborhood disadvantage, objectively or subjectively measured, is a robust correlate of HIV vulnerability.
• Associations between neighborhood factors and drug use were more consistently documented than for sexual risk behaviors.
• Limited geographic distribution of studies, with underrepresentation in critical high-prevalence areas.

Conclusions:

• Neighborhood influences on HIV vulnerability stem from historical racialized inequities and policies.
• Multi-level, neighborhood-based strategies are essential to address these injustices and eradicate HIV.
• Findings inform future research, interventions, and policies for HIV prevention and eradication.