Victoria Frye

Migration, neighborhoods, and networks: approaches to understanding how urban environmental conditions affect syndemic adverse health outcomes among gay, bisexual and other men who have sex with men.

Adopting socioecological, intersectionality, and lifecourse theoretical frameworks may enhance our understanding of the production of syndemic adverse health outcomes among gay, bisexual and other men who have sex with men (MSM). From this perspective, we present preliminary data from three related studies that suggest ways in which social contexts may influence the health of MSM. The first study, using cross-sectional data, looked at migration of MSM to the gay resort area of South Florida, and found that amount of time lived in the area was associated with risk behaviors and HIV infection. The second study, using qualitative interviews, observed complex interactions between neighborhood-level social environments and individual-level racial and sexual identity among MSM in New York City. The third study, using egocentric network analysis with a sample of African American MSM in Baltimore, found that sexual partners were more likely to be found through face-to-face means than the Internet. They also observed that those who co-resided with a sex partner had larger networks of people to depend on for social and financial support, but had the same size sexual networks as those who did not live with a partner. Overall, these findings suggest the need for further investigation into the role of macro-level social forces on the emotional, behavioral, and physical health of urban MSM.

Social Support Among Women in Methadone Treatment Who Experience Partner Violence Isolation and Male Controlling Behavior

This study explores types, availability, use, and satisfaction of support among women in methadone treatment who reported partner violence. It also examines the role of the womans intimate partner in isolating her from her social network. A total of 68 women participated in 1 of 14 two-hour focus groups. The findings suggest that male dominance and control function to isolate and prevent women from accessing support needed to cope with partner violence. The participants not only felt that they had few people to turn to for support but also expressed dissatisfaction with the support that they received.

The Distribution of and Factors Associated With Intimate Terrorism and Situational Couple Violence Among a Population-Based Sample of Urban Women in the United States

It has been proposed that two distinct forms of intimate partner violence exist: intimate terrorism and situational couple violence. This article describes the distribution of factors that characterize intimate terrorism and situational couple violence, including controlling behaviors, violence escalation, and injury, among a representative sample of 331 physically assaulted women living in 11 North American cities. In addition, respondent, partner, and relationship characteristics associated with each form of violence are identified. Most women who experienced physical assault also experienced controlling behavior by their male partner. In multivariate analyses, respondents young age, violence escalation in the relationship, partners access to guns, previous arrests for domestic violence offenses, poor mental health, and previous suicide attempts or threats were associated with intimate terrorism, defined as experiencing one or more controlling behaviors. These results suggest that situational couple violence is rare and that moderate and high levels of controlling behaviors are associated primarily with partner factors.

Exploring the role of housing type, neighborhood characteristics, and lifestyle factors in the community integration of formerly homeless persons diagnosed with mental illness

Background: Little is still known about what community, individual and program factors contribute to the successful community integration of formerly homeless persons diagnosed with severe mental illness (SMI). Aims: The goal of this study was to use blended quantitative and qualitative methods to examine the impact of housing type (independent apartments and congregate settings) and neighborhood characteristics on physical, social and psychological aspects of community integration in this population. Method: Forty-four persons who had been stably housed for at least one year completed quantitative and qualitative assessments examining different aspects of community integration. Neighborhood structural variables were also examined using census data. Results: Quantitative findings confirm that community integration is multidimensional, and that different aspects of housing and neighborhood influence different dimensions of community integration. The concept of “locus of meaningful activity” (a lifestyle characteristic) emerged as an important construct from qualitative analyses. Locus of meaningful activity was associated with greater psychological integration and was linked to housing type. Conclusions: Findings offer direction for future studies seeking to understand the factors that influence the community integration of formerly homeless persons with SMI. Declaration of interest: Two authors are affiliated with Pathways to Housing, which provides services to homeless persons with SMI.

Intimate Partner Violence Perpetration Against Main Female Partners Among HIV-Positive Male Injection Drug Users

Intimate partner violence (IPV) against women is a serious public health and social problem and is associated with a host of adverse health outcomes and behaviors, HIV risk behaviors included, among women who are victimized. Historically, research has focused on correlates of IPV victimization among women; thus, there is less information on the role of men in perpetrating IPV, particularly among men at risk for transmitting HIV to their female partners. We assessed the self-reported prevalence and correlates of perpetration and threat of perpetration of physical and/or sexual IPV against a main female partner among 317 HIV-positive men who were current injection drug users (IDUs). More than 40% of men reported perpetrating physical (39%) and/or sexual (4%) violence against their main female partners in the past year. Multivariate analyses revealed that low education, homelessness, psychologic distress, and unprotected sex with main and nonmain HIV-negative female partners were positively associated with IPV perpetration against main female partners. These findings reveal that IPV perpetration is prevalent among HIV-positive male IDUs and associated with sexual HIV transmission risk behaviors. IPV assessment and treatment among HIV-positive men in HIV care is recommended as a way to prevent IPV perpetration and victimization and to reduce potential HIV transmission.

Neighborhood-Level Correlates of Consistent Condom Use among Men Who have Sex with Men: A Multi-Level Analysis.

There is growing evidence that the neighborhood environment influences sexual behavior and related outcomes, but little work has focused specifically on men who have sex with men (MSM). Using interview data from a probability sample of 385 young MSM living in New York City, recruited at public venues in 1999 and 2000 as part of the Young Men’s Survey-New York City, and data on neighborhood characteristics obtained from the U.S. Census 2000, we conducted multi-level analyses of the associations between neighborhood-level characteristics and consistent condom use during anal intercourse, while controlling for individual-level sociodemographic and other factors. After adjusting for individual-level factors, neighborhood-level gay presence remained significantly and positively associated with consistent condom use during anal intercourse. This finding suggests that neighborhoods with a significant gay presence may have norms that act to discourage high risk sexual activity.

The Urban Environment and Sexual Risk Behavior among Men who have Sex with Men

Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.

The Role of Neighborhood Environment and Risk of Intimate Partner Femicide in a Large Urban Area

OBJECTIVES We evaluated the contribution of neighborhood-level factors indicative of social disorganization, including educational and occupational attainment, immigrant concentration, physical disorder, and social cohesion, to the likelihood of intimate partner femicide (IPF) while taking into account known neighborhood- and individual-level IPF risk factors. METHODS We used medical examiner data on 1861 femicide victims between 1990 and 1999 and archival information on 59 neighborhoods in New York City to conduct a multilevel case-control analysis. RESULTS After controlling for neighborhood-level income, we found that no neighborhood factors were significantly associated with IPF risk, as compared with risk of non-IPF and risk of femicide from unknown perpetrators, above and beyond the contributions of individual-level factors. The strongest predictors of IPF were foreign country of birth and young age. CONCLUSIONS IPF victims were nearly twice as likely as non-IPF victims to be foreign born; by contrast, there was little neighborhood-level heterogeneity with respect to IPF risk. Further research is needed to identify neighborhood characteristics that uniquely influence risk of IPF to guide community-level interventions.

Physical and sexual intimate partner violence among women in methadone maintenance treatment

Although several studies have examined the relationship between intimate partner violence (IPV) and drug use among women in drug treatment programs, more information is needed to delineate differences, as a function of the specific drug used. Data from a random sample of 416 women attending methadone programs were analyzed to elucidate the differential associations between IPV and use of the following: marijuana only, cocaine only, heroin only, or cocaine and heroin. Prevalence of IPV among this sample far exceeded estimates from the general population. After adjusting for sociodemographic variables, use of cocaine only was significantly associated with an increased likelihood of experiencing IPV compared with no drug use. Similar results were found for women using both cocaine and heroin.

Femicide and Social Disorganization

In the United States, homicide is a leading cause of death among young women. In New York City between 1990 and 1997, although the overall number of femicides declined markedly, intimate partner femicides increased. The reason for this is unclear. Sociostructural accounts of homicide rates have traditionally focused on the importance of socioeconomic factors indicative of social disorganization. A feminist critique of this perspective suggests that such factors are less important to intimate partner femicide. Using census data on community-level sociostructural factors and surveillance data on femicides between 1990 and 1997 in New York City, the authors evaluate the relative importance of sociostructural factors in models of intimate partner and non-intimate partner femicide.