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Where We Live Matters: Social Determinants of HIV Risk

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An overview of social factors contributing to HIV risk, including Philadelphia-specific information and maps.

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Where We Live Matters: Social Determinants of HIV Risk

  1. 1. WHERE WE LIVE MATTERS: SOCIAL DETERMINANTS OF HIV RISK Presented by
  2. 2. TOPICS TO BE DISCUSSED • Racial/Ethnic Populations Distribution • Socio-economic Status  Poverty  Educational Attainment • Neighborhood Stability • Crime/Violence • Theft • Assault • Homicide • STDs • HIV/AIDS
  3. 3. DEMOGRAPHICS INCOME ENVIRONMENT SOCIAL/ POLITICAL / ECONOMIC OUR PLACE DETERMINES OUR HEALTH But all of these factors determine our place
  4. 4. 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
  5. 5. SOCIAL DETERMINANTS – WHAT?  Health is impacted by where we live, work, play and learn  Many factors outside of our control impact health and well being  Our early life experiences affect later health
  6. 6. SOCIAL DETERMINANTS • Social and economic factors are extremely powerful predictors of death and ill-health across a wide range of diseases and injuries • Three distinct components: – Socio-economic determinants • Age, sex, education – Psycho-social risk factors • Social support, self esteem, chronic stress – Community and societal characteristics • Income inequality, level of trust, social capital
  7. 7. SOCIOECONOMIC DETERMINANTS Age Gender Race Ethnicity Education Employment Occupation Income Religion Housing
  8. 8. PSYCHOSOCIAL RISK FACTORS  Poor social networks  Low self-esteem  Self-efficacy  Depression  Anxiety  Insecurity  Loss of sense of control  High physical/ psychological demand  Chronic stress  Isolation  Anger/hostility  Coping  Perception/ expectations
  9. 9. COMMUNITY AND SOCIETAL CHARACTERISTICS  Social networks  Social and community participation  Civic and political involvement  Trust in people and social institutions  Tolerance of diversity  Altruism, charity work  Poverty  Residence (urban, rural)  Income inequality  Crime rate  Domestic violence  Unemployment rate
  10. 10. SOCIO-ECONOMIC STATUS AND HEALTH  Association between health and socio- economic status is causal  Our social and economic status can be the cause of either declining health or illness/disease  As income/education/status increase, health and well being increases (Ansari, Carson et. al, 2003)
  11. 11. SOCIAL DETERMINANTS AND HIV • Where we live affects health and HIV risk behaviors – Living in a socially disadvantaged neighborhood can lead to fatalism, risky coping mechanisms (substance abuse, risky sexual behaviors) – Some communities have limited or no access to health information or medical/mental health services – Social networks impact sexual and drug use behaviors and health
  12. 12. SOCIAL NETWORKS
  13. 13. WHO’S IN OUR SOCIAL NETWORK MATTERS Composition of social networks impacts HIV risk  Individual risk is not determined by personal risk behavior alone, but also the “pool” of disease in their sexual/drug using networks (Augustine and Bridges, 2008; Adimora & Schoenbach, 2005; Aral, Adimora, Fenton, 2008)
  14. 14. WHO’S IN OUR SOCIAL NETWORK MATTERS Composition of social networks impacts HIV risk  Factors impacting the intensity of HIV in a network:  Density – how many people in a network have had sexual contact with each other  Sorting – tendency of people with similar characteristics (race, age, neighborhood) to associate with one another and not others outside the community  Mixing – when someone has sexual contact with someone outside their primary network  Concurrent partnerships – having more than one sexual partner at a time
  15. 15. CONCURRENT PARTNERSHIPS  Concurrent sexual partnerships or partnerships that overlap in time raise HIV transmission risks more than having multiple consecutive monogamous partnerships.  Recent research found that African American men had 2.56 higher odds of engaging in concurrent relationships as White men.  Poverty, substance use and abuse, and incarceration are associated with concurrent partnerships (Nunn, Dickman, Cornwall, et. al 2011)
  16. 16. SEX RATIO IMBALANCE  Some African American communities have more females than males  Due to high infant mortality and death to violence and disease, as well as high incarceration rates  Imbalance grows as the population age increases – more boys for children, less males in elderly population  Imbalance affects behavior of both males and females, in terms of concurrency and risk behaviors  Women may perceive a shortage of men and tolerate behavior/risk they might not otherwise  Men have some leverage in relationships, because there are other women available
  17. 17. 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)
  18. 18. HEALTH/MORTALITY
  19. 19. HEALTHCARE SYSTEM • Most socioeconomically disadvantaged populations tend to use more primary and secondary health services, but make less use of prevention services like: prenatal care, immunizations, health screening and dental services • Primary health services – regular doctor visits • Secondary health services – treatment of specialists to manage/cure disease
  20. 20. MORTALITY  Black:White ratios of mortality from coronary heart disease, cancer and diabetes were larger in 1990s than 1950s.  Researchers at CDC estimated that 38% of the excess mortality among Black adults compared to White adults was related to differences in income  Krieger et. al estimated if everyone experienced the mortality of the wealthiest 20% of Whites, between 1960 and 2002 we would have avoided:  14% of premature deaths among Whites  30% of premature deaths for Blacks (Williams & Collins, 2001; Woolf & Braverman, 2011)
  21. 21. RACE AND ETHNICITY Segregation and social factors
  22. 22. RACIAL/ETHNIC COMPOSITION  Philadelphia population: 1,526,006  White: 626,221 or 41.0 %,  46,893 Male & 66,239 Female below the poverty level (2009)  Black: 661,839 or 43.4 %  79,976 Male & 111,335 Female below the poverty level (2009)  Hispanic: 172,483 or 11.3%  31,600 Male & 37,799 Female below the poverty level (2009)  Asian: 96,405 or 6.3%  Male 9,877 & 9,835 Female below the poverty level (2009) (US Census Data)
  23. 23. 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)
  24. 24. 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.  Many segregated areas have high levels of multiple sources of stress including:  Violence  Financial stress  Family separation  Chronic illness  Death  Family turmoil (Williams & Collins, 2001; Woolf & Braverman, 2011)
  25. 25. EDUCATIONAL ATTAINMENT AND INCOME
  26. 26. 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 (RWJ, 2011)
  27. 27. EDUCATIONAL ATTAINMENT  Residential segregation has led to highly segregated primary and secondary schools and is the fundamental cause of racial differences in the quality of education  Children’s health is strongly linked to their parents’ education, particularly mother’s
  28. 28. PHILADELPHIA- EDUCATIONAL ATTAINMENT  80% of Philadelphians 25 years and older have HS diploma/GED or greater  6% less than 9th grade  13.4% have 9-12th grade  16.6% Some college/no degree  12.8% Bachelor’s degree  9.8% Graduate degree  Philadelphia drop out rate is 3.37% in 2010, highest in PA
  29. 29. 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  Chronic stress or stress during critical periods can lead to illness in adulthood through the neuroendocrine (nervous system transmitters), immune, inflammatory pathways/systems  Chronic diseases like diabetes and heart disease  Low birth weight, prematurity  Neuroendocrine problems with lifelong effects (some cancers (RWJF, 2011)
  30. 30. POVERTY AND FAMILIES  Average Family Income -$45,842 (in 2009 inflation adjusted $’s)  Philadelphia has highest poverty rate of the 10 largest cities Total Families Married Couple Families with own children under 18 present Male Householder no wife present with own children under 18 Female Householder no husband present with own children under 18 311,055 64,488 or 20.73% 13,818 or 4.44% 64,800 or 20.83% Families below poverty line in 2009 inflation- adjusted $ 59,827 8,056 or 13.47% 4,271 or 7.14% 33,734 or 56.39%
  31. 31. 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)
  32. 32. VIOLENCE AND SOCIAL DISADVANTAGE
  33. 33. SOCIAL DISADVANTAGE AND VIOLENCE People with limited income and social support/resources are more likely to:  Have social networks which include others of limited means and ability to provide support and comfort  Experience social disorganization  Experience conditions which deepen feelings of anger, frustration, hopelessness which may make it more likely to resort to violence  Have peers who engage in and encourage violent responses to conflict (RWJF, 2011)
  34. 34. LINKS BETWEEN VIOLENCE AND HEALTH  Violence can affect health-related behaviors  Violence-associated stress affects motivation and capability to adopt and adhere to health-promoting behaviors and/or increases the use of health-harming coping behaviors  Violence-related stress may lead to poorer health  Chronic stress has been linked to more rapid onset and progression of chronic illnesses and bodily wear and tear (which accelerates aging)  Violence can influence health through its impact on social and economic conditions  Violence can lead to widespread feelings of fear, distrust and isolation  Violence can act as an obstacle to investments in health- promoting community resources and opportunities (supermarkets, jobs, parks) (RWJ, 2011)
  35. 35. NEIGHBORHOOD CHARACTERISTICS  Extremely disadvantaged neighborhoods are characterized by a high degree of social isolation from mainstream society  Most profound effects of living conditions may be delayed consequences that unfold over a lifetime  Higher vacancy rates and greater prevalence of renters produce significantly higher levels of property crime  Many studies have found relationships between neighborhood disadvantage and health, even after considering individual characteristics (behavior, income, etc.)  Distressed homes and neighborhoods can induce disease (lead, allergens, pollution)  Shortage of health care providers, especially primary care (Krivo & Peterson, 1993; Woolf & Braverman, 2011)
  36. 36. HOMICIDE  Higher levels of relative and absolute deprivation are associated with higher levels of homicide  Black-White segregation leads to higher rates of Black killing (stranger and acquaintance homicides)  Social isolation may act as the mechanism (Peterson & Krivo, 1993)
  37. 37. STIS AND HIV
  38. 38. SEXUALLY TRANSMITTED INFECTIONS Social determinants create the epidemiological context for individual behaviors and STI transmission:  SES is one of the most important determinants of sexual health  High unemployment rates, low mean income and low education levels are associated with higher STI rates  Disparities in incarceration rates and high mortality for Black males have lead to disproportionate sex ratios in some communities (more women than men) (Hogben and Leichter, 2008; Thomas, Torrone, et al., 2009)
  39. 39. 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 (CDC MMWR 8/12/2011, Logan, Cole & Leukefield, 2002)
  40. 40. HIV/AIDS National and Local Epidemiological Contexts
  41. 41. NATIONAL INCIDENCE DATA  Estimated 48,100 HIV infections in 2009 in adults and adolescents (95% CI, 42,200 – 54,000)  Estimated incidence 19.0 infections per 100,000 population  44% among blacks, 20% Latinos  61% among MSM, 27% heterosexual  39% among 13-29 year olds (AACO, 2011)
  42. 42. 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+
  43. 43. 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
  44. 44. LOCAL INCIDENCE ESTIMATE - RACE 2009 HIV Diagnoses 62% 38% Black Non-Black 2009 HIV Incidence 63% 37% Black Non-Black N=913 N=941
  45. 45. LOCAL INCIDENCE ESTIMATE - AGE 2009 HIV Diagnoses 25% 48% 27% 13-24 25-44 45+ 2009 HIV Incidence 30% 53% 17% 13-24 25-44 45+ N=913 N=941
  46. 46. LOCAL INCIDENCE ESTIMATE - MODE 2009 HIV Diagnoses 50% 14% 36% MSM IDU Hetero 2009 HIV Incidence 47% 14% 39% MSM IDU Hetero N=913 N=941
  47. 47. Mistrust of Health Care System Unsafe/ Unstable Neighborhoods Unprotected Sex Drug and Alcoho l Abuse Incarceration Social Inequality Historic and Modern Inequality Increased Risk of HIV and STD Concurrent Partnerships (Advocates for Youth, 2008)
  48. 48. 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 (PHMC, 2011)
  49. 49. INCOME AND HIV  Material 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 (CDC MMWR 8/12/2011)
  50. 50. Fairmont Park Cobbs Creek Park Phila Int. Airport Clark Park Pennypack Park Northeast Airport La Salle
  51. 51. nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend nmLa Salle, City Hall Airport Runway FCC Parks Rivers and Streams tracts BLACK POP % 0.07% - 4.44% 4.45% - 12.75% 12.76% - 32.4% 32.41% - 69.17% 69.18% - 94.44% 94.45% - 98.65% Zip Code Boundaries 0 0.8 1.60.4 Miles BLACK POPULATION
  52. 52. HISPANIC POPULATION nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend nmLa Salle, City Hall Airport Runway FCC Parks Rivers and Streams tracts HISPANIC POP % 0.26% - 1.24% 1.25% - 1.88% 1.89% - 2.75% 2.76% - 4.22% 4.23% - 10.01% 10.02% - 88.49% Zip Code Boundaries 0 0.8 1.60.4 Miles
  53. 53. WHITE POPULATION nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend nmLa Salle, City Hall Airport Runway FCC Parks Rivers and Streams tracts WHITE / POP2000 0.28% - 2.41% 2.42% - 16.5% 16.51% - 45.3% 45.31% - 73.6% 73.61% - 90.16% 90.17% - 100% Zip Code Boundaries 0 0.8 1.60.4 Miles
  54. 54. FEMALE-HEADED HOUSEHOLDS WITH CHILDREN, 2010 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend nm La Salle, City Hall Zip Code Boundaries Airport Runway FCC Parks Rivers and Streams tracts FHH_CHILD / HOUSEHOLDS 0.34% - 3.99% 4% - 6.93% 6.94% - 11.34% 11.35% - 16.44% 16.45% - 20.32% 20.33% - 50% 0 0.8 1.60.4 Miles
  55. 55. LIVING BELOW POVERTY, 2010 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend nmLa Salle, City Hall Airport Runway FCC Parks Zip Code Boundaries Rivers and Streams tracts TPOPBELP / POP2010 1.19% - 8.34% 8.35% - 13.04% 13.05% - 19.97% 19.98% - 29.04% 29.05% - 38.28% 38.29% - 83.13% 0 0.8 1.60.4 Miles
  56. 56. LESS THAN HIGH SCHOOL, MALES > 25, 2010 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend nmLa Salle, City Hall Airport Runway FCC Parks Zip Code Boundaries Rivers and Streams tracts M12THGNL / POP2010 0% 0.01% - 5.85% 5.86% - 8.1% 8.11% - 10.73% 10.74% - 13.17% 13.18% - 56.79% 0 0.8 1.60.4 Miles
  57. 57. LESS THAN HIGH SCHOOL, FEMALES >25, 2010 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend nmLa Salle, City Hall Airport Runway FCC Parks Zip Code Boundaries Rivers and Streams tracts F12THGNL / POP2010 0% 0.01% - 6.54% 6.55% - 10.07% 10.08% - 13.21% 13.22% - 16.73% 16.74% - 37.5% 0 0.8 1.60.4 Miles
  58. 58. LICENSE AND INSPECTION DEMO, 2005 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend nmLa Salle, City Hall Airport Runway FCC Parks Zip Code Boundaries Rivers and Streams tracts LIDEMORATE05 / HSE_UNITS 0% 0.01% - 0.16% 0.17% - 0.68% 0.69% - 1.74% 1.75% - 4.79% 4.8% - 43.31% 0 0.8 1.60.4 Miles
  59. 59. L & I PENDING DEMO, 2005 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend nmLa Salle, City Hall Airport Runway FCC Parks Zip Code Boundaries Rivers and Streams tracts .LIPENDDEMO05 0 1 - 4 5 - 10 11 - 20 21 - 36 37 - 128 0 0.8 1.60.4 Miles
  60. 60. THEFTS, 2011 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend Thefts nm La Salle, City Hall Airport Runway FCC Parks Rivers and Streams Zip Code Boundaries 0 0.8 1.60.4 Miles
  61. 61. ASSAULTS – DOMESTIC, 2011 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend Assault-Domestic nm La Salle, City Hall Airport Runway FCC Parks Rivers and Streams Zip Code Boundaries 0 0.8 1.60.4 Miles
  62. 62. ASSAULTS, 2011 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend Assaults nm La Salle, City Hall Airport Runway FCC Parks Rivers and Streams Zip Code Boundaries 0 0.8 1.60.4 Miles
  63. 63. HOMICIDES, 2011 nm nm 1915319153 1912819128 1915419154 1911419114 1911119111 1913619136 1913119131 1911619116 1914519145 1912419124 1914819148 1911519115 1913419134 1914419144 1911819118 1911919119 1914319143 1912019120 1910419104 1915219152 1914019140 1913519135 1912119121 1913719137 1914919149 1913219132 1915119151 1912919129 1913919139 1911219112 1914119141 1914619146 1913819138 1914219142 1912519125 1914719147 1915019150 1912319123 1912219122 1913019130 1913319133 1912619126 1910619106 1912719127 1910319103 1910719107 1911319113 1910219102 Legend Homicide 2011 nmLa Salle, City Hall Airport Runway FCC Parks Rivers and Streams Zip Code Boundaries 0 0.8 1.60.4 Miles
  64. 64. 1915319153 1912819128 1915419154 1911419114 1911119111 1911619116 1914519145 1912419124 1913119131 1913619136 1914819148 1911519115 1914419144 1913419134 1910419104 1911819118 1911919119 1914319143 1912019120 1915219152 1914019140 1912119121 1913519135 1914919149 1913219132 1915119151 1912919129 1913919139 1914119141 1911219112 1914619146 1913819138 1914219142 1915019150 1914719147 19125191251912219122 1913019130 1913319133 1912319123 1913719137 1912619126 1912719127 19106191061910319103 1910719107 1911319113 Legend Airport Runway FCC Rivers and Streams FCC Parks Zip Code Boundaries 1 Dot = 30 Export_Output.chlamydiarates Export_Output.syphillisrate Export_Output.gonorrhearate $ 0 3 61.5 Miles STD RATES, 2008
  65. 65. 1915319153 1912819128 1915419154 1911419114 1911119111 1911619116 1914519145 1912419124 1913119131 1913619136 1914819148 1911519115 1914419144 1913419134 1910419104 1911819118 1911919119 1914319143 1912019120 1915219152 1914019140 1912119121 1913519135 1914919149 1913219132 1915119151 1912919129 1913919139 1914119141 1911219112 1914619146 1914219142 1915019150 1914719147 1912219122 1913019130 1913319133 1912319123 1913719137 1913819138 1912519125 1912619126 1912719127 19106191061910319103 1911319113 Legend Airport Runway Rivers and Streams FCC Parks Zip Code Boundaries tracts PLWHA / POP2008 0.000 0.001 - 0.006 0.007 - 0.011 0.012 - 0.016 0.017 - 0.024 0.025 - 3.222 0 1 20.5 Miles $ PERCENT PLWHA PER CENSUS TRACT, 2008
  66. 66. 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
  67. 67. FOR FOLLOW UP/QUESTIONS Office of HIV Planning 340 N. 12th Street Suite 203 Philadelphia, PA 19107 215-574-6760 www.hivphilly.org Mari Ross Russell, Director (Maps/GIS) Mari.rossrussell@gmail.com Nicole Johns Nicole.johns@gmail.com

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