Methods: A cross-sectional secondary data analysis using spatial and self-reported data from the 2009 trial of the WORTH HIV/STI intervention. We examined associations and interactions between HIV/STI drug and sexual risk behaviors, recent homelessness, and living in risky neighborhoods among a sample of drug-using women in community corrections in New York City (N=337). “Risky neighborhoods” is defined as high (vs. low) frequency of precinct-level 911 calls associated with drug-use-, sex-, and partner violence-related crimes.
Results: We found 1) significant interactions between neighborhood risk and homelessness history upon individual drug and sexual risk behaviors; and 2) significant differences between women in community corrections with and without recent homeless histories. Living in high-risk neighborhoods (i.e. neighborhoods with higher incidents of drug use-related crimes) was significantly associated with higher amounts of certain types of illicit drug-use (i.e. cocaine, crack and ecstasy) among recently homeless participants. Conversely however, neighborhoods high in drug use-related crimes were associated with lower rates of transactional sex behaviors (i.e. sex with paying partners among recently homeless women in community corrections. Living in low risk neighborhoods (i.e. those low substance-use related crimes) was associated with less use of certain forms of illicit drug-use, such as, cocaine and heroin and greater amounts of transactional sex among recently homeless study participants. For study participants who did not report recent homelessness, living in low risk substance-use related crime neighborhoods was associated with more cocaine and ecstasy use. In addition, living in neighborhoods with low in intimate partner violence-related crimes was associated with less ecstasy use among participants without recent homeless histories.
Conclusions and Implications: In light of the ongoing need to "End Homelessness" and "Close the Health Gap" experienced by particularly vulnerable populations such as recently homeless women in community corrections, findings from this study has implications across multiple social work grand challenges. Living in risky neighborhoods, high in substance use-related crimes, is significantly associated with higher cocaine, crack, and ecstasy drug use and lower rates of survival sex among recently homeless women in community correction. For women in community corrections who did not experience recent homelessness however, residing in low risk substance-use related crime neighborhoods was associated with greater amounts of illicit substance use cocaine and ecstasy. Given these identified interactions between neighborhood risks, recent homelessness, and HIV/STI drug and sexual risk behaviors, there is a public health need to address adverse neighborhood conditions and the veneer of safety housing offers to this high-risk population. Leveraging these findings, we will present recommendations that feature a nuanced discussion regarding intervention 1) adaptation, 2) targeting, and 3) delivery to maximize reach to female community corrections populations at risk. We will also discuss the use of geospatial analysis as a vehicle to unearth complex associations when analyzing HIV/STI drug and sexual risk behaviors engaged in by women in community corrections.