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Gays in the neighborhood: How neighborhood and context impact HIV and substance use risks and resiliencies of gay, bisexual and other men who have sex with men in New York City

Egan, James E. (2015) Gays in the neighborhood: How neighborhood and context impact HIV and substance use risks and resiliencies of gay, bisexual and other men who have sex with men in New York City. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Thirty years into the HIV pandemic gay, bisexual, and other men who have sex with men (MSM) are still disproportionately impacted by HIV/AIDS, accounting for two-thirds of the U.S epidemic. There is increasing evidence that context is an important driver of HIV risk. This dissertation was designed to summarize the literature on the influences of neighborhoods on MSM health and to explore three contextual moments of heightened HIV risk using data from the NYCM2M study (N=1493). Migration: There is a well-established history of gay migration to NYC. These data support that migration is an important moment of heightened HIV risk for MSM. More recent migrants to NYC had increased risk for condomless sex and heavy drinking compared to men in NYC for longer. Compared to White MSM, Black and Latino MSM had a greater proportional hazard of seroconverting within the first ten years of migration. Community Viral Load (CVL): Where MSM live and have sex is not random, but constructed by socio-historical factors. These findings suggest that differences may be an important determinant in the social epidemiology of HIV. Compared to White MSM, Black MSM had greater odds of living in and having sex in higher CVL neighborhoods, Latino MSM had greater odds of a higher CVL sex neighborhood. Both Black MSM and bisexuals had greater odds of migrating to higher CVL spaces (than White gay men). White MSM who migrated had greater odds for condomless sex than those who did not. Substance Use: Elevated substance use has been documented among MSM, particularly those in cities. These findings show significant between neighborhood differences in any drug use and hazardous drinking (home and social) and heavy drinking (social) suggesting that neighborhood factors uniquely influence substance use behaviors among MSM. Without substantial changes to the implementation of HIV treatment/prevention, we will continue to fall short of our potential impact. Although context/place has considerable promise as a location for HIV prevention efforts, it has been underemphasized. This dissertation is a step towards addressing this gap, suggesting contextual opportunities for multi-level public health HIV interventions to reduce HIV among MSM.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Egan, James E.jee48@pitt.eduJEE48
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairStall, Ronald D.rstall@pitt.eduRSTALL
Committee MemberSharma, Ravirks1946@pitt.eduRKS1946
Committee MemberSilvestre, Anthony J.tonys@pitt.eduTONYS
Committee MemberHerrick, Amy Lalh75@pitt.eduALH75
Date: 28 January 2015
Date Type: Publication
Defense Date: 25 November 2014
Approval Date: 28 January 2015
Submission Date: 20 November 2014
Access Restriction: 4 year -- Restrict access to University of Pittsburgh for a period of 4 years.
Number of Pages: 113
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: HIV/AIDS; MSM; gay men; substance use; migration; neighborhoods; community viral load; New York City; HIV risk behaviors
Date Deposited: 28 Jan 2015 16:07
Last Modified: 01 Jan 2019 06:15
URI: http://d-scholarship.pitt.edu/id/eprint/23545

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