Poor Urban Dwellers At Greater Risk of Contracting, Dying from AIDS

Amy Nunn, ScD, MS Assistant professor (research) of Behavioral and Social Sciences Brown University School of Public HealthMedicalResearch.com Interview with:
Amy Nunn, ScD, MS
Assistant professor (research) of Behavioral and Social Sciences
Brown University School of Public Health

MedicalResearch.com: What are the main findings of the study?

Answer: The main findings are that people living in poor, mostly-minority urban neighborhoods, where health resources such as HIV testing and linkages to care are often lacking, are at a greater risk of contracting HIV and dying of AIDS. This is not because of differences in behavior. It’s because they live in medically underserved areas where HIV incidence is very high and fewer people know their status. Fewer people knowing their status means fewer people on treatment. Fewer people on treatment means it’s easier for people to come into contact with the virus, even if they don’t engage in any higher risk behavior.

In the paper, my colleagues and I call for increasing the focus of public health efforts on these neighborhoods where the epidemic is concentrated and contributing heavily to racial and economic disparities in AIDS mortality.

MedicalResearch.com: Were any of the findings unexpected?

Answer: Even for people who are well versed in the extent of the epidemic, it can still be shocking that HIV incidence is eight times higher for African-Americans and three times higher among Hispanics than among whites. In some of the urban neighborhoods we discuss in the paper, the reported rates of infection rival those reported in sub-Saharan Africa.

We also found that your chances of surviving with HIV are a function of where you live in the United States.

Lastly, we demonstrated that several campaigns have been effective in promoting HIV screening and treatment across entire neighborhoods. These campaigns should be replicated in other parts of the country.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: The epidemic is heavily concentrated in certain neighborhoods of many cities, such as New York, Philadelphia, Washington DC, and across the Deep South. Clinicians who are practicing medicine in areas of the country with high rates of HIV infection should be offering everyone who walks into their office an HIV test as part of their routine clinical care. In our Philadelphia project, a federally qualified health center we partner with offers HIV screening at the same time that patients’ vital signs are taken. This is a very effective way to address this problem.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: I and some of my co-authors have been engaged in such campaigns (I’ve been working in Philadelphia, PA and Jackson, Miss.) Others have been working in other cities. We need to study the results and best practices of working in neighborhoods with media, local institutions and leaders and by going door-to-door to promote testing and treatment. Then we need to generate new campaigns and assess their impact. We also need to engage community leaders in these communities to ask them how to do this in a way that makes sense for their neighborhoods.


Amy Nunn, Annajane Yolken, Blay Cutler, Stacey Trooskin, Phill Wilson, Susan Little, Kenneth Mayer. Geography Should Not Be Destiny: Focusing HIV/AIDS Implementation Research and Programs on Microepidemics in US Neighborhoods. American Journal of Public Health, 2014; 104 (5): 775 DOI: 10.2105/AJPH.2013.301864

Last Updated on April 11, 2014 by Marie Benz MD FAAD