Social stability and HIV risk: Exploring the role of multidimensional social vulnerability

Background. Social stability is an understudied construct with promise for understanding the extent and types of vulnerability experienced among urban populations. Social stability also offers a useful framework to understand the synergy of social vulnerabilities that form the context for and contribute to HIV transmission risk among urban populations. This study: (1) synthesized the existing literature on social stability; (2) investigated prevalence and patterns of co-occurrence among a set of social stability characteristics; (3) evaluated the possibility of underlying sub-groups of social stability; and (4) examined the extent to which indicators of social stability and two measures of multidimensional social stability were associated with HIV-related risk variables among a sample of primarily African-American, low-income women at risk for HIV. Methods. Data were from comprehensive baseline interviews with women and their female social network members (n=635) enrolled in an HIV prevention intervention in Baltimore, MD. Analysis included exploratory statistics, logistic regression, latent class analysis, and latent class regression accounting for clustered data using Stata and Mplus software. Stata version 10 and Mplus version 5 were used for analysis. Results. Literature review identified a set of six common domains of social stability: housing, residential mobility, employment, partner relationship, income, and incarceration. Analytic results supported the premise that this set of characteristics represents a single construct with identifiable underlying sub-groups. Individual indicators varied in their association with HIV-related outcomes and supported investigation of the cumulative impact of stability across domains. Both a cumulative and latent class measure of multidimensional social stability was associated with HIV-related risks, with differing implications. Conclusions. Results reinforce that instability characteristics tend to co-occur, but with heterogeneity. Findings also indicate that the co-occurrence of instability contributes to HIV risk. Future research should investigate socio-demographic and health characteristics associated with social stability. These findings add to the calls for attention to structural health determinants and provide a framework for evaluating social and contextual factors in social service and HIV prevention programs