Wallace Robert G
CUNY Graduate School and Department of Biology, City College of New York, Marshak Building, CCNY, 138th Street and Convent Avenue, New York City, NY 10031, USA.
Soc Sci Med. 2003 Mar;56(6):1155-71. doi: 10.1016/s0277-9536(02)00121-1.
During the 1990s, the number of new AIDS cases in New York City, USA, declined precipitously. The declines, beginning before highly active antiretroviral therapy (HAART) was introduced, were geographically heterogeneous across two New York City boroughs analyzed. From 1993 to 1998, zip codes in Lower Manhattan, with large white and affluent populations, had declines as much as 55% more than the rest of Manhattan. Bronx zip codes underwent still lesser declines. Declines also differed within zip codes among subpopulations. White zip code populations tended to have greater declines than Latino populations, which in turn tended to have greater declines than black populations. According to bivariate and stepwise regressions, an array of socioeconomic and community stress variables acted in combination on the decline in New York AIDS. Manhattan's declines in total AIDS incidence were primarily defined by changes in AIDS incidence for whites and for men who have sex with men, racial segregation, and the proportions of households in upper income classes and under rent stress. Bronx declines in total AIDS are principally explained by a broader range of income classes, and social instability as marked by housing overcrowding and cirrhosis and drug mortalities. Whatever the combination of proximate causes for the decline in AIDS incidence in 1990s New York (educational campaigns, HAART, demographic stochasticity), the decline was shaped by the city's socioeconomic structure and political and ecological history. That structure and history generates the geographically defined aggregates of behaviors that promote or impede AIDS decline. Such spatial heterogeneity may provide for HIV refugia, areas where the virus can weather the epidemic's contraction, a troubling possibility with the accelerating microbicidal failures of combination therapies.
在20世纪90年代，美国纽约市的新增艾滋病病例数急剧下降。这些下降在引入高效抗逆转录病毒疗法（HAART）之前就已开始，在所分析的纽约市两个行政区中呈现出地理上的异质性。从1993年到1998年，曼哈顿下城白人及富裕人口众多的邮政编码区域的下降幅度比曼哈顿其他地区多55%。布朗克斯区邮政编码区域的下降幅度则更小。邮政编码区域内不同亚人群的下降情况也有所不同。白人邮政编码区域的人口下降幅度往往大于拉丁裔人口，而拉丁裔人口的下降幅度又往往大于黑人人口。根据双变量和逐步回归分析，一系列社会经济和社区压力变量共同作用于纽约艾滋病病例数的下降。曼哈顿艾滋病总发病率的下降主要由白人以及男男性行为者的艾滋病发病率变化、种族隔离以及高收入阶层家庭比例和面临租金压力的家庭比例所决定。布朗克斯区艾滋病总发病率的下降主要由更广泛的收入阶层以及以住房拥挤、肝硬化和药物死亡率为标志的社会不稳定因素所解释。无论20世纪90年代纽约艾滋病发病率下降的直接原因组合如何（教育宣传活动、HAART、人口统计学随机性），这种下降都受到该市社会经济结构以及政治和生态历史的影响。这种结构和历史产生了在地理上界定的促进或阻碍艾滋病下降的行为聚集。这种空间异质性可能会形成HIV庇护所，即病毒能够在疫情收缩期间存活下来的区域，鉴于联合疗法的杀菌失败加速，这是一个令人担忧的可能性。
