"We Live in Different Chicagos": Racial/Ethnic Differences in the Neighborhood Affiliations of Young Men Who Have Sex with Men as Drivers of HIV Risk.

Racial disparities in HIV are well-documented and pervasive, particularly impacting Black young men who have sex with men (YMSM), and are not explained by differences in individual risk behaviors. The Network-Individual-Resource (NIR) Model of HIV Transmission and Prevention (Johnson et al. in AIDS Behav 14:S204-S221, 2010) suggests that focusing on the broader network-level environments of YMSM holds strong promise for identifying social-contextual factors that may drive these racial disparities. Empirically, numerous studies have demonstrated links between neighborhood-level factors and HIV risk among YMSM (Bauermeister et al. in J Sex Res 54:446-464, 2017). This mixed-methods study aimed to characterize racial differences in the broader contexts (i.e., neighborhood affiliations) within which YMSM meet their sex partners, which may in turn shape HIV risk. Using an innovative explanatory sequential design, multilevel network and geospatial data from an existing longitudinal cohort of YMSM in Chicago were visualized (Phase 1) and subsequently used to guide interviews with a subsample of participants in the broader parent study (Phase 2). Grounded theory was used to analyze interview data, leading to the identification of several salient differences in Black, White, and Latino YMSM's neighborhood-level affiliations, including racial segregation and resource inequality, White spatial insularity, profound Black-White segregation, and Black and Latino neighborhood bridging. From a network perspective, these racial differences in neighborhood-level affiliations have strong potential to help explain the disproportionate burden of HIV among Black YMSM. Findings highlight the importance of attending to the social context within which individual risk behaviors take place and underscore the importance of broader structural change to address racial disparities in HIV.