The social environment of an area, including factors such as poverty, stress, and living conditions, contributes to the disease burden. A recent study published in AJPH shows that patients from a disordered environment don’t stick to their medication schedule, even for a potentially lethal condition like HIV. As the researchers found, residents of highly disordered neighborhoods will sell or trade their antiviral medication rather than taking it and adhering to their drug plans.

Poverty, a condition often associated with specific geographic regions or neighborhoods, is linked to many poor health outcomes. People living in poverty often lack access to nutritious food, good healthcare, strong social support, and other structural advantages that can ensure better health. Neighborhood disorder theory focuses on the role of economic disadvantage as a driver of adverse health outcomes among residents of poor neighborhoods. In previous studies, neighborhood disorder has been linked to increased HIV risk-taking behavior, which helps explain why HIV infections tend to cluster in areas with higher poverty and other forms of risk taking.

For this study, researchers interviewed 503 socioeconomically disadvantaged HIV-positive substance users, approximately half of whom were selling or trading their antiviral medication to other HIV positive individuals who didn't have access to regular antiviral medication. Participants were from neighborhoods in urban Miami that have high and persistent levels of both HIV infections and poverty. Additionally, environmental risk factors were examined for these neighborhoods, such as prevalence of HIV and poverty levels.

The researchers found that higher levels or neighborhood disorder significantly reduced the adherence to HIV antiviral medication plans. Additionally, the data showed that if you knew someone who sells or trades their antivirals, you would be at greater risk of participating in that same behavior. The researchers posit that this “network effect” merits future further investigation.

The findings of this study support the idea that there’s an HIV risk environment that influences an individual’s HIV-related vulnerabilities. Though this study presents a strong case for neighborhood disorder as an influence on HIV treatment, up to 70 percent of the population studied in this environment continued to take their antivirals despite environmental stressors.

For those who failed to take their medication as recommended, reducing the need for illicit antiviral medication could limit non-adherence. The researchers recommend a public prescription service to cover those who are lacking access to appropriate medication. Additionally, environmental supports, such as affordable housing and other services could further limit the risk of selling or trading antiviral medication instead of taking it, because stronger social and environmental support structures would relieve some of the financial and environmental pressures to sell this medication.

Though it doesn’t come as a surprise that stressful environments result in poor health outcomes, it does seem surprising that this phenomenon is far-reaching enough to affect something as potentially deadly as HIV treatment. The important take-home message of this new study is that environmental factors have a serious impact on even the most acutely dangerous illnesses and shouldn’t be overlooked when examining public health or medical trends.

American Journal of Public Health, 2015. DOI: 10.2105/AJPH.2015.302612 (About DOIs)