This project uses the theory of eco-social epidemiology to enhance the social work perspectives on social justice and person in environment to correct the tendency to focus on individual level change interventions in public health and social work in the HIV sectors. In doing so, it moves beyond a single lens exploration of risk factors to a deeper examination of the multiple relationships that exist between risk co-factors, sexual networks and high-risk behavior among Black MSM. Using secondary analysis of data collected during the quantitative phase of the CDC-funded Brothers y Hermanos (ByH) research project (2003-2006), the project explored the structural, socio-cultural, psychological, and behavioral dimensions relevant to understanding risk for transmitting or contracting HIV for 614 MSM who identified as Black among the ByH respondents, of whom 36.3% reported being negative, indeterminate or unaware of their HIV status. A quarter (24.9%) of participants were between 41-45 years of age, followed by age group 46-50 years (18.1%). 63% resided in NYC for 21 years or more, with 15.3% having resided in New York for 5 years or less, and 6% residing in the region between 16-20 years.
Path analysis was used to provide estimates of the magnitude and significance of causal connections between HIV risk cofactors sexual network factors and HIV risk behavior. The analysis found no direct or indirect interactions among HIV risk co-factors and HIV behavior risk factors (UAIr) with the specified model demonstrating poor fit (x2 = 187.54, df = 45, p = .000), CFI = .007, RMSEA = .072). Additionally, the analysis found no direct or indirect interactions among HIV risk co-factors, sexual network factors and HIV behavior risk factors (x2 = 191.14, df = 88, p = .000), CFI = .808, RMSEA = .044 although the model accounted for almost 81% of variance in UAIr.
The findings demonstrate the need to move beyond stereotypic perceptions of Black MSM to a more dynamic appreciation of the interactive aspects of their environments. Second, the findings underscore the need for social workers to act as allies and change agents through research and problem definition. And, they reflect the need for social workers to engage in policy analysis that investigates the significance of changed policies or ineffective interventions that differentially impact poor communities in general and specific members of these communities. The interventions designed to address the disproportionate rates of sero-conversion and transmission of HIV among Black MSM must consider the complex real world phenomena that contribute to these disparities. Interventions require attention to methods and policies that are contextually driven. Grounded in demands for social justice, it is incumbent upon social welfare to act—by organizing community and challenging existing structural and institutionalized polices. This being the case, we must conduct client assessments that surface important information concerning risks, as well as levels of functioning and interactions within the community, using tools that assist workers to identify service delivery needs over the life span, including education, histories of violence, incarceration, exposure to discrimination and substance use. Lastly, social work must begin to reconceptualize consumer participation and engagement in social work throughout their contact with consumers and engage members of all communities with whom programs are affiliated. Social workers, educators, researchers and organizations must become concerned with the past, present and future biographies of clients and their communities. Best practices must be conceptualized as launch pads to enhancing operations and require the organization to match its technology to the intersection of needs of its stakeholders and their communities.
