COMMUNITY DISRUPTION AND HIV/AIDS IN THE DISTRICT OF COLUMBIA
September 13-14, 2012
American University
Neighborhood Change and Gentrification Presentations Jeffrey “Bart” Bingenheimer, PhD, MPH: Assistant Professor, Department of Prevention and Community Health, School of Public Health and Health Services, The George Washington University “Neighborhood Mortality and Age at First Intercourse among Chicago Adolescents” • Bingenheimer's research examined the neighborhood conditions, including neighborhood mortality rates, that may increase the likelihood of early sexual debut, which is associated with a greater likelihood of teen pregnancy, HIV, and STIs. However, his analysis was unable to isolate different neighborhood level factors from the impact of neighborhood mortality rates, and thus he was unable to draw related conclusions. Andrew Deener, PhD: Assistant Professor, Department of Sociology, University of Connecticut “Neighborhood Change and the Reconfiguration of Groups” • Deener presented his case study of Venice, CA and how gentrification and neighborhood change lead to community disruptions, but also the ways in which communities can preserve diversity and mitigate disruption from development. Laura Tach, PhD: Assistant Professor, Department of Policy Analysis and Management, Cornell University, “De-­‐Concentrating the Poor: How Public Housing Demolition Influences Health Environments and Health Behaviors” • Tach discussed her research on urban redevelopment in the Housing Opportunities for People Everywhere (HOPE VI) program analyzing a range of factors affecting HIV and other health risks. According to her analysis, redevelopment appeared to be associated with residents' decreased exposure to illegal drugs, risky sexual activities (among stayers), and residential instability and homelessness. However, she also found increased isolation and disruption of networks among both movers and stayers, little change in utilization of screening and preventive care services and only minor changes in the availability of on-­‐site services and linkages to community based organizations. Shannon M. Monnat, PhD: Assistant Professor, Department of Sociology, University of Nevada, Las Vegas, “Geographic Correlates of HIV Risk Behavior and Utilization of HIV Testing” • Monnant's research looked at the association between a variety of county-­‐level contextual factors and individual level risky sexual and testing behaviors. Most 1 Community Disruption and HIV/AIDS In the District Of Columbia, Sept 13-14, 2012 American University were not associated with risk and testing behaviors. Dr. Monnat suggested a number of possible untested sources of variation to explore further, including community intervention efforts, patterns of social networks, presence of law enforcement, and existing health care services. Key themes: • Researchers are interested in how neighborhood level conditions and context affect health outcomes, but research faces challenges in measuring and assessing neighborhood level impacts. • Potential neighborhood factors that impact HIV and health include neighborhood opportunity structures, hazards and safety risks, and collective efficacy, neighborhood mortality rates, feelings of uncertainty and anxiety, social ties, drug use, sexual activity, access to healthcare and preventative care, residential stability and homelessness, and support services. • Development and gentrification can disrupt neighborhood social networks and processes and lead to demographic changes, segregation, housing instability, anxiety and insecurity. However, communities are also resilient and find ways to reduce disruptions. • The disruptions caused by gentrification can increase risk for HIV, but more research is needed on the impacts of disruption on at-­‐risk populations and on relevant neighborhood conditions and social processes that most affect health. Gentrification and movement of populations could potentially create bridging communities that promote transmission and/or prevention of HIV and other STIs. • Research is needed that examines the processes of gentrification and neighborhood change, particularly variations in these processes by race, class and age. Immigration patterns, particularly amongst Latinos, are leading to larger communities in suburban areas, which have implications for heath risks, social ties and access to health resources. Age specific patterns may also be related to the health impacts of neighborhood change. Neighborhood Change Working Group Research gaps: • Gentrification needs to be defined and operationalized. • Do not know if DC neighborhoods most affected by HIV are undergoing change • Little information on how and where people decide to move. • Need to understand the stocks and flows of people and institutions into and out of neighborhoods. • Need to understand how neighborhood change impacts connection and access to HIV care. • As poor people most at risk for HIV/AIDS move from DC to suburbs in MD and VA, there may be changes in HIV/AIDS infections and transmissions. Community Disruption and HIV/AIDS In the District Of Columbia, Sept 13-14, 2012 American University 2 •
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More research is needed to understand both the positive and negative impacts of gentrification and the different impacts for various communities and populations, as well as the impacts on the larger metropolitan region and counties and towns surrounding cities if people are displaced from urban areas. The impact of policies and urban development on HIV risk, care and prevention is not known. Research questions: • How do population stocks and flows of both people and institutions influence HIV risk? Need to conceptualize neighborhood change and understand where people come from and where they go. • What are the behavior and HIV risk changes associated with different types of neighborhood change? • What happens to social safety nets through social networks and government and nonprofit agencies when neighborhoods change? When people move do they lack access to clinics and HIV treatment? • How do we integrate data collection across DC/MD/VA? Important as people move between these boundaries and to understand the DC metro region. • How do sex and drug networks change? How do sex partners change with migration? • Do diseases such as HIV/AIDS change neighborhoods? • How do social service and community-­‐based organizations respond to these changes – do they move with their clients or adapt to a different population and community? What happens to people when they move? Do they lose their social safety net and treatment services? • Does HIV/AIDS impact people’s moving decisions? Do people stay near their clinics in order to maintain treatment? • What neighborhood institutions, infrastructure and services are most important for HIV/AIDS care and prevention? What factors predict the opening and closing of institutions and organizations in a neighborhood? Potential research projects: • Do preliminary research through existing data but also conduct new surveys and interviews that can inform and guide interventions. • Connect community health impact study to new development projects. • Examine demographic shifts as well as changing institutions, services and retailers. • Project about education, awareness and prevention. • Using existing data to pilot and promote a health impact assessment policy for new development. • Map geographic and social networks particularly friendship, sexual and drug use networks. Sources of data and methodologies: Community Disruption and HIV/AIDS In the District Of Columbia, Sept 13-14, 2012 American University 3 •
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Case control studies that incorporate neighborhood contextual data, however these will only capture people seeking treatment. Small structural intervention, such as housing, microfinance and HIV testing Interviews and micro-­‐level qualitative data. Mine existing longitudinal datasets, ex. NIH and NIDA surveys, but might not include HIV data. New representative research to study connections between people and places, social networks. Collaborate with different agencies to pool data. Via the WIHS project at Georgetown University Medical Center there is longitudinal data on men and women that has addresses, but are confidential and stored locally so need to find way to geocode and separate from individual identifiers. Get new data or combine existing data that allows for mapping social and geographic networks. Other potential activities: • Create and circulate concept sheets. • Collaborate with the six institutions in DC D-­‐CFAR. • Encourage NIH and other researchers and funders to consider neighborhood change in relation to HIV research and interventions. Community Disruption and HIV/AIDS In the District Of Columbia, Sept 13-14, 2012 American University 4