Living in a disadvantaged urban neighborhood can
increase a male resident's risk of contracting HIV,
according to researchers at the Johns Hopkins
Bloomberg School of Public
Health. Their study related disadvantaged neighborhoods
to stress and stress to increased injection drug use in
male study participants. This is the first empirical study
that illustrates how neighborhood characteristics may
directly lead to HIV infection. The study is published in
the January issue of Health Psychology.
Carl A. Latkin, lead author of the study and an
associate professor in the school's
Department of Health Policy and Management, explained
that HIV rates are known to differ by geographic location
and that disadvantaged urban areas tend to have high rates
He said, "Past studies have shown a consistent
relationship between socioeconomic status and health, but
the ways in which neighborhood characteristics impact
health behaviors are poorly understood. Our findings show
how neighborhood characteristics and stressors such as
crime, abandoned buildings, loitering, unemployment,
crowding and litter lead to greater depression. Individuals
who have high levels of depression tend to take more
illicit drugs and engage in more risk behaviors."
The researchers examined data from a survey of 701
injection drug users from the Self-Help in Eliminating
Lethal Disease, or SHIELD, Study, an HIV prevention
intervention in Baltimore. They found that psychological
distress or feelings of hopelessness and helplessness are
higher in more socially deprived neighborhoods and that
stress leads to greater injection frequency and needle
sharing. They also learned that an increase in injection
drug use leads drug users to share drug equipment. The
researchers did not see a clear correlation between stress
and injection frequency in female study participants.
The researchers note that depression is often viewed
as a personal or individual attribute that should be
treated with medication or psychotherapy. However, the
results of this study suggest that depression may be due in
part to living in stressful, disadvantaged neighborhoods.
Needle exchange programs, neighborhood revitalization
projects and assistance with obtaining legal employment can
improve neighborhood quality and reduce stressors,
according to the study authors.
"The perceived lack of control over the environment or
feelings of entrapment due to fear of those involved in
drug economy and other criminal activities may be a
constant threat to self and self-concept for some
neighborhood residents. As it not feasible or desirable to
treat large numbers of depressed individuals with therapy
or medication, preventive interventions are needed to
address impoverished neighborhood residents' physical and
social disorder," Latkin said.
The study authors were supported in part by grants
from the National Institute on Drug Abuse.
Co-authors of the study from the School of Public
Health include Chyvette T. Williams, Jian Wang and Aaron D.