Where We Live Matters: January 2013 Update

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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.

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  • Concurrent relationships provide for different needs. Main partners offer emotional support and companionship while non-main partners may offer financial, housing or other supports.Among low income African Americans, concurrency is perceived as the norm.Lack of trust in partners, main and non-main also influenced concurrencyTrust also impacts condom use. Condoms more likely to be used with non-main partners.Lack of trust in community, affect marital decisions and concurrent partnerships. Lack of trust is related to lack of social capital in the community. High crime rates, low marriage rates and high poverty rates are associated with low levels of neighborhood social capital, low socioeconinomic status and poor health outcomes.Substance use
  • 661, 839 42.7%
  • 11.15% or 172,483 Asians are 96,405 6.23% Nat amer a little less than 7,000
  • 40.47 or 626,211
  • Total male 719,813 >25=446,524
  • Female 806,193 > 25 621,028
  • Poverty is not a social driver, per se. It is the context in which people are poor that can lead to relational patterns resulting in forms of sexual networking that can spread HIV Earlier onset of sexual activity occasional transactional sex
  • 574,413 total households for whom income was determined.16.8% <$10,0008.4 10 to 14,99913.8 15 to 24,99916.2 50 to 74,999Median household income $34,40027.9% social security10.7% SSI22.1 some public assistance including food stamps39.7 public health insuranceEmployed –no health ins. 17%Unemployed –no health ins 46.1%21.3% of all families below poverty level31.3 Poverty children under 18, 27% with children under 5
  • There were 68,550 or 11.4 total female headed households with their own children present.Total households 599,736
  • 1151
  • 7636
  • 391
  • Black population total 661, 839 = a little over 13,000
  • Social drivers are understood not as unilateral variables that can be studied adequately in terms of causal, one-to-one relationships between any of them and HIV infection outcomes….they are interactive phenomena reflective of social and cultural processes, institutional practices, and sets of arrangements that facilitate HIV transmission or its prevention.Social drivers are complex, fluid, non-linear,and contextual, and they interact dynamically with biological, psychological, behavioral and other social factors
  • The CDC reported august of 2011 in the mmwr that there is an association between poverty and risk behaviors.
  • 913
  • Where We Live Matters: January 2013 Update

    1. 1. WHERE WE LIVE MATTERS:SOCIAL DETERMINANTS OF HIV RISK Presented by
    2. 2. OUR PLACE DETERMINES OUR HEALTH SOCIAL/But all of POLITICAL /these factors ECONOMICdetermine our DEMOGRAPHICS ENVIRONMENTplace INCOME
    3. 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
    4. 4. Socioeconomic Status Environment Health
    5. 5. Social Risky coping HIV riskDisadvantage behaviors
    6. 6. SOCIAL NETWORKS
    7. 7. 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
    8. 8. SOCIAL NETWORK DENSITY Density – how many people in a network have had sexual contact with each other
    9. 9. 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
    10. 10. 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
    11. 11. CONCURRENT PARTNERSHIPS
    12. 12. SEX RATIO IMBALANCE Incarceration Death by Infant accident and mortality homicide More women than men
    13. 13. 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)
    14. 14. SOCIOECONOMIC FACTORSSegregation, poverty and social factors
    15. 15. 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)
    16. 16. Northeast Fairmont Airport Park PennypackClark Park ParkCobbsCreekParkPhila Int.Airport
    17. 17. BLACK POPULATION 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Rivers and Streams 19145 19145 tracts 19148 19148 BLACK POP % 0.07% - 4.44% 4.45% - 12.75% 12.76% - 32.4% 19112 19112 19153 19153 32.41% - 69.17% 69.18% - 94.44% 94.45% - 98.65% Zip Code Boundaries 19113 19113 0 0.40.8 1.6 Miles
    18. 18. HISPANIC POPULATION 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Rivers and Streams 19145 19145 tracts 19148 19148 HISPANIC POP % 0.26% - 1.24% 1.25% - 1.88% 1.89% - 2.75% 19112 19112 19153 19153 2.76% - 4.22% 4.23% - 10.01% 10.02% - 88.49% Zip Code Boundaries 19113 19113 0 0.40.8 1.6 Miles
    19. 19. WHITE POPULATION 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Rivers and Streams 19145 19145 tracts 19148 19148 WHITE / POP2000 0.28% - 2.41% 2.42% - 16.5% 16.51% - 45.3% 19112 19112 19153 19153 45.31% - 73.6% 73.61% - 90.16% 90.17% - 100% Zip Code Boundaries 19113 19113 0 0.40.8 1.6 Miles
    20. 20. RACIAL/ETHNIC DISPARITIESCompared 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)
    21. 21. RACIAL SEGREGATION AND SOCIALFACTORS 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.
    22. 22. 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
    23. 23. LESS THAN HIGH SCHOOL, MALES > 25, 2010 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Zip Code Boundaries 19145 19145 Rivers and Streams 19148 19148 tracts M12THGNL / POP2010 0% 0.01% - 5.85% 19112 19112 19153 19153 5.86% - 8.1% 8.11% - 10.73% 10.74% - 13.17% 13.18% - 56.79% 19113 19113 0 0.40.8 1.6 Miles
    24. 24. LESS THAN HIGH SCHOOL, FEMALES >25, 2010 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19123 19123 19139 Legend 19104 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Zip Code Boundaries 19145 19145 Rivers and Streams 19148 19148 tracts F12THGNL / POP2010 0% 0.01% - 6.54% 19112 19112 19153 19153 6.55% - 10.07% 10.08% - 13.21% 13.22% - 16.73% 16.74% - 37.5% 19113 19113 0 0.40.8 1.6 Miles
    25. 25. 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
    26. 26. THE GAP WIDENSBetween 2005 and 2009 the average net worthof households decreased considerably: • Fell by 16% Whites • From $134,992 to $113,149 • Fell by 53% Blacks • From $12,124 to $5,677 • Fell by 66% Hispanics • From $18,359 to $6,325 (Woolf & Braverman, 2011)
    27. 27. LIVING BELOW POVERTY, 2010 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 Legend 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 m n La Salle, City Hall 19143 Airport 19146 19146 19147 19147 Runway FCC Parks 19142 19142 Zip Code Boundaries 19145 19145 Rivers and Streams 19148 19148 tracts TPOPBELP / POP2010 1.19% - 8.34% 8.35% - 13.04% 19112 19112 19153 19153 13.05% - 19.97% 19.98% - 29.04% 29.05% - 38.28% 38.29% - 83.13% 19113 19113 0 0.40.8 1.6 Miles
    28. 28. FEMALE-HEADED HOUSEHOLDS WITHCHILDREN, 2010 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19122 19122 19151 19151 19125 19125 Legend 19130 19139 19139 19104 19104 19130 19102 19102 19123 19123 m n La Salle, City Hall 19143 m n 19103 19107 19103 19107 19106 19106 Zip Code Boundaries Airport 19143 19146 19146 19147 19147 Runway FCC 19142 19142 Parks 19145 19145 19148 19148 Rivers and Streams tracts 19112 19112 FHH_CHILD / HOUSEHOLDS 19153 19153 0.34% - 3.99% 4% - 6.93% 19113 19113 6.94% - 11.34% 11.35% - 16.44% 0 0.40.8 1.6 Miles 16.45% - 20.32% 20.33% - 50%
    29. 29. 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 Health Violence (RWJ, 2011)
    30. 30. ASSAULTS – DOMESTIC, 2011 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 19143 19146 19146 19147 19147 Legend Assault-Domestic 19142 19142 19145 19145 19148 19148 m n La Salle, City Hall Airport Runway 19112 19112 19153 19153 FCC Parks Rivers and Streams 19113 19113 Zip Code Boundaries 0 0.40.8 1.6 Miles
    31. 31. ASSAULTS, 2011 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 19143 19146 19146 19147 19147 Legend Assaults 19142 19142 19145 19145 19148 19148 m n La Salle, City Hall Airport Runway 19112 19112 19153 19153 FCC Parks Rivers and Streams 19113 19113 Zip Code Boundaries 0 0.40.8 1.6 Miles
    32. 32. HOMICIDES, 2011 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19144 19144 m n 19141 19141 19120 19120 19149 19149 19136 19136 19127 19127 19124 19135 19135 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19139 19139 19123 19123 19104 19104 19102 19102 19143 m n 19103 19107 19103 19107 19106 19106 19143 19146 19146 19147 19147 19142 19142 Legend Homicide 2011 19145 19145 19148 19148 m n La Salle, City Hall Airport Runway 19112 19112 19153 19153 FCC Parks Rivers and Streams Zip Code Boundaries 19113 19113 0 0.40.8 1.6 Miles
    33. 33. Unemployment High Incarceration STI ratesLow income
    34. 34. STD RATES, 2008 19116 19116 19154 19154 19115 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19138 19138 19126 19126 19119 19119 19128 19128 19136 19136 19141 19141 19149 19149 19144 19120 19120 19144 19127 19127 19135 19135 $ 19124 19124 19129 19129 19140 19140 19132 19132 19137 19137 19133 19133 19131 19131 19134 19134 19121 19121 19151 19151 19122 19122 19125 19125 19130 19130 19123 19123 19139 19139 19104 19104 19103 19103 19106 Legend 19106 19143 19107 19107 Airport 19143 19146 19146 19147 19147 Runway 19142 19142 FCC 19145 19145 Rivers and Streams 19148 19148 FCC Parks 19112 19112 19153 19153 Zip Code Boundaries 1 Dot = 30 19113 19113 Export_Output.chlamydiarates Export_Output.syphillisrate Miles Export_Output.gonorrhearate 0 1.5 3 6
    35. 35. 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
    36. 36. HIV/AIDSNational and Local Epidemiological Contexts
    37. 37. 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+
    38. 38. 2009 ESTIMATE OF HIVINCIDENCE - 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
    39. 39. Mistrust of Health Care System SocialInequalityHistoric and Modern Inequality Increased Risk of HIV and STD Drug and Alcoho l Abuse Unprotecte d Sex Unsafe/ Unstable Concurrent Incarceration Neighborhoods Partnerships (Advocates for Youth, 2008)
    40. 40. NEIGHBORHOOD CHARACTERISTICS ANDHIV 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
    41. 41. 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
    42. 42. PERCENT PLWHA PER CENSUSTRACT, 2008 19116 19116 19115 19154 19154 19115 19118 19118 19150 19150 19114 19114 19111 19111 19152 19152 19119 19138 19126 19138 19126 19119 19128 19128 19141 19141 19136 19136 19149 19149 $ 19144 19144 19120 19120 19127 19127 19135 19135 19124 19124 19129 19129 19140 19140 19132 19132 19137 19137 19131 19133 19133 19134 19131 19134 19151 19121 19121 19151 19122 19125 19122 19125 Legend 19130 19130 19123 Airport 19139 19139 19104 19104 19123 Runway 19103 19106 19103 19106 Rivers and Streams 19143 19143 FCC 19146 19146 19147 19147 Parks Zip Code Boundaries 19142 19142 tracts 19145 19145 19148 PLWHA / POP2008 19148 0.000 0.001 - 0.006 19112 19112 0.007 - 0.011 19153 19153 0.012 - 0.016 0.017 - 0.024 19113 19113 0.025 - 3.222 0 0.5 1 2 Miles
    43. 43. 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

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