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.