University of Pennsylvania School of Nursing professor Bridgette Brawner says public health researchers have been making the case for decades: Inequities in education and income matter to health.
Her new analysis adds to what many have known for some time: some of Philadelphia’s neighborhoods with the highest rates of HIV also have the highest proportion of people who are struggling financially.
Brawner calls that a “geobehavioral vulnerability.”
“If we take that to HIV, if we acknowledge and accept that those things matter, strict individual level interventions cannot work in isolation,” she said.
Historically the fight against HIV has focused on what people do. And the fixes, she says, have mostly been attempts to change behavior.
Philadelphia has done a lot of work in telling people to use condoms — as well as helping them find a clinic to get tested.
Brawner wants people to know that their economic standing and where they live also play a role in the HIV-risk equation.
“Ok, now that I know that I’m in an area where I might be more likely to be exposed to HIV, or I might have a greater risk of coming across someone who’s positive,” Brawner said, “then my sexual life looks different. You, unfortunately, don’t have the same liberties as someone who’s, let’s say, living in an area of Wyoming, where we know the rates are lower.”
Brawner’s team has already mapped different socio-economic factors and linked them to HIV rates in the city. Her next step is to see if Philadelphia’s HIV treatment and testing agencies are serving the hardest hit communities.
She’s looking to fill holes in the system.
About 19,000 people are living with HIV in Philadelphia. The city’s infection rate is five times the national average.