Nicole Johns of the Office of HIV Planning presented this updated version of the very popular "Where We Live Matters" to the Positive Committee on January 14, 2013.
3. WHAT FACTORS IMPACT HEALTH?
• Genetics
• Access to medical care
• Health literacy
• Social networks
• Stress levels/coping mechanisms
• Income
• Social Stigma (racism, sexism, ageism, etc.)
• Education
• Safety/Violence
• Water, air, and soil quality
• Access to healthy foods
• Working conditions
• Transportation
8. WHO’S IN OUR SOCIAL NETWORK MATTERS
Individual risk is not determined by personal risk
behavior alone, but also the “pool” of disease in
their sexual/drug using networks
9. SOCIAL NETWORK DENSITY
Density – how many people in a network have had sexual
contact with each other
10. SORTING IN SOCIAL NETWORKS
Sorting – tendency of people with similar
characteristics (race, age, neighborhood) to
associate with one another and not others outside
the community
11. MIXING IN SOCIAL NETWORKS
Mixing – when someone has sexual contact with someone
outside their primary network
Concurrent partnerships – having more than one sexual
partner at a time
14. PHILADELPHIA FACTORS - CONCURRENCY
Philly has the 4th highest incarceration rate in the
U.S. – 5.7 per 100 residents
Nearly 45% of African Americans have never been
married
Fewer than 10% of individuals living below the
poverty line are married
Philly has sex ratio of .82 for African Americans
(Nunn, Dickman, Cornwall, et. al 2011)
21. RACIAL/ETHNIC DISPARITIES
Compared with Whites, Black and Hispanics:
Generally
Earn less income and have less schooling
At the same educational level, have lower
incomes
At the same educational/income level, are more
likely to have grown up in disadvantaged
circumstances
At a given income level
Have less wealth (all earnings, properties, investments)
Live in unstable neighborhoods
(RWJF 2011)
22. RACIAL SEGREGATION AND SOCIAL FACTORS
Race may help determine place, but people of
different ethnic/racial groups experience similar
health outcomes in severely disadvantaged
neighborhoods
Segregation is the primary cause of racial
differences in socio-economic status (SES)
The worst urban context in which Whites live is
better than the average context for Black
communities.
23. EDUCATIONAL ATTAINMENT
Educational attainment affects health through:
Health knowledge
Employment and income
Sense of control
Social networks
People with more education are more likely to:
Live longer
Experience better health outcomes
Practice health-promoting behaviors
Have close friends on whom they can rely
Have greater family stability and supportive marriages
26. POVERTY AND CHRONIC STRESS
Poverty/near poverty is often
stressful because so much
time/energy devoted to daily
tasks and securing
necessities
Stress can lead to harmful
coping mechanisms like
smoking, drug use and risky
sex
27. THE GAP WIDENS
Whites
• Fell by 16%
• From $134,992 to $113,149
Blacks
• Fell by 53%
• From $12,124 to $5,677
Hispanics
• Fell by 66%
• From $18,359 to $6,325
Between 2005 and 2009 the average net worth
of households decreased considerably:
(Woolf & Braverman, 2011)
30. LINKS BETWEEN VIOLENCE AND HEALTH
Violence can affect health-related behaviors
Violence-related stress may lead to poorer health
Violence can influence health through its impact on
social and economic conditions
(RWJ, 2011)
Health
Violence
36. STIS AND HIV
CDC identified higher HIV prevalence among
heterosexual individuals who had previously
received an STI diagnosis (4.0%) vs. those who did
not (1.7%)
Transmission and acquisition of HIV may be
increased up to 10 times by the presence of other
sexually transmitted infections
38. HIV IN PHILADELPHIA
25,563 people are living with HIV/AIDS in the
Philadelphia 9 county region, almost 75% of those
live in Philly
Estimated another 5,000 HIV+ people are not
aware of HIV+ status
Philly’s HIV incidence rates are 4 times national
average
It is estimated that 2% of African Americans in Philly
are HIV+
39. 2009 ESTIMATE OF HIV INCIDENCE -
PHILADELPHIA
Local estimate of 941 new HIV infections in 2009 in
adults and adolescents (95% CI, 659 – 1,222)
Case rate of 76.8 new HIV infections per 100,000
population
4 times the national rate
90% increase in incidence among youth, 13-24
between 2006 to 2009
Driven by increases in young, black, MSM
41. NEIGHBORHOOD CHARACTERISTICS AND HIV
Philadelphia neighborhoods with high rates of HIV
(GENERALLY) have these characteristics:
Low socio-economic status
High concentration of Black/African American
residents
High death rates due to homicide, AIDS,
septicemia or other illness
High birth risk
High neighborhood instability
High crime rates of multiple types
42. INCOME AND HIV
Poverty is associated with an increase in risk
behaviors
CDC found HIV prevalence associated with
socioeconomic status:
Prevalence higher among those :
With less than high school education* (2.8%)
Incomes at or below poverty* (2.3%)
Unemployed *(2.6%)
Homeless (3.1%)
*statistically significant differences
45. ADDITIONAL RESOURCES
Office of HIV Planning – Epidemiological profile and
Geographic Risk Analysis
http://www.hivphilly.org/documents.html
CDC:
http://www.cdc.gov/socialdeterminants/
World Health Organization:
http://www.who.int/social_determinants/en/
Robert Wood Johnson Foundation
Vulnerable Populations Portfolio
www.rwjf.org/vulnerablepopulations