Neighborhood Violence and Safety: Report from the MACS WIHS Combined Cohort Study

Neighborhood violence and safety concerns are associated with poor health outcomes including HIV acquisition/transmission, and possible lack of viral suppression. Using a cross-sectional analytic design, we determined the prevalence of neighbourhood violence and safety concerns among participants in the MACS WIHS Combined Cohort Study, a large US cohort of men and women with and without HIV. We used multivariable logistic regression to assess factors associated with perceptions of neighborhood violence (weapon and gang fights, sexual assault, robbery or mugging) and safety concerns (feeling safe walking at night). Most participants perceived their neighborhoods as violent (59%) and unsafe (69%). Black participants, women, those with lower income, less formal education, substance use, and those with higher levels of stress, depressive symptoms, and frailty scores had greater odds of perceiving neighborhood violence and safety concerns. Among women, those who missed ≥1 HIV clinic appointment were twice as likely to report their neighborhoods as unsafe. Women reporting marijuana use (OR 1.29, 95% CI: 1.00, 1.646) or meeting the definition for frailty (OR 1.37, 95% CI: 1.04, 1.83) reported higher odds of neighborhood violence. Among men, smoking or substance use were associated with higher odds of perceiving violence and safety concerns. Men with depressive symptoms were more than twice as likely to report neighborhood safety concerns than men without symptoms. The intersection of previous HIV-related risk factors and reported neighborhood violence and safety emerged as highly significant and warrants efforts to better understand and address structural challenges to comprehensive care for people with HIV.