Neighborhood crime and sexual behavior among Black men living with HIV in Los Angeles, CA

Background:  Black men are disproportionately impacted by HIV and are more likely to live in crime-ridden neighborhoods. Exposure to crime predisposes residents to depression and drug use, which are associated with increased sexual risk. Efforts to prevent sexual HIV transmission have focused on individual predictors and not on the environmental context. Here, we examined the association of neighborhood crime, independent of individual-level characteristics, with sexual behavior among Black men living with HIV.

Methods:  HIV-positive Black men on antiretroviral therapy in Los Angeles, California completed an audio computer-assisted self-interview measuring demographics and behavior. Participant addresses were geocoded. Crime risk per census block group was obtained from the National Uniform Crime Report. Multivariate logistic regression was used to generate adjusted estimates of associations between neighborhood crime and sexual behavior.

Results:  Among 193 men, 36% reported having multiple partners during the last 3 months [among sexually active, mean (SD)=2.7 (3.3) sexual partners], 36% reported condomless sex, and 43% reported sex with an HIV-negative or unknown status partner. In univariate analysis, crime (violent and non-violent) (p=0.003), depression (p=0.05), and drug use (p=0.002) were significantly associated with multiple sexual partners in the past 3 months. Crime [AOR=1.49, 95%CI (1.13–1.97)] and drug use [AOR=3.13, 95%CI (1.52-6.47)] remained significant in multivariate analysis. No significant associations emerged between crime and condomless sex or sex with an HIV-negative/unknown partner.

Conclusion:  Among Black men living with HIV, neighborhood crime is associated with having multiple sexual partners. Interventions to reduce transmission risk should incorporate structural components to reduce potential crime exposure.