Wallace R
Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, New York, NY.
Environ Res. 1988 Oct;47(1):1-33. doi: 10.1016/s0013-9351(88)80018-5.
Techniques adapted from population and community ecology, quantitative geography, and epidemiology are applied to ecosystem and environmental index data on the Bronx in an attempt to understand the origins and potential impacts of rampant spread of human immunodeficiency virus (HIV) and its sequelae of acquired immunodeficiency syndrome (AIDS) in that borough: Recent work by Drucker and Vermund (1987), ("Estimating Prevalence of Human Immunodeficiency Virus Infection in Urban Areas with High Rates of Intravenous Drug Abuse: A Model of the Bronx in 1987," Poster presented at the Third International Conference on AIDS, June 2, 1987) estimates HIV seroprevalence levels of from 8 to 21% among men of age 25-44 in the south Bronx, at this writing, comparable to the cities of Central Africa. It is found that the "South Bronx" process of fulminating, contagious urban decay which devastated the region in the 1970s, and its associated forced population migrations, spread intravenous drug abuse, the principal HIV vector in the Bronx, from a geographically contained center in the South-Central Bronx to a virtually borough-wide phenomenon. This has significantly complicated attempts to contain HIV infection, both by shredding the social networks which are the natural vehicles for education, and by vastly enlarging the area requiring intensive targeting. Since the "planned shrinkage" municipal service cuts which triggered the "South Bronx" burnout persist, and since levels of housing overcrowding now approach those of the early 1970s in the Bronx, it is expected that a new outbreak of contagious urban decay will occur, likely again dispersing population and seriously compromising any in-place HIV control strategies. If overt AIDS itself becomes a contributor to urban deterioration in overcrowded neighborhoods susceptible to "South Bronx" process, we could then see a nonlinear ecosystem coupling between AIDS, contagious urban decay, and population shift. Elementary mathematical models are provided. Thus, in striking contrast to the middle-class male homosexual community, successful control of HIV infection in the Bronx, and by inference in other devastated ghetto communities, seems predicated on quick reestablishment of demographic stability: The tools to make the tools for control must first be reconstructed. Necessary elements of any program toward this end are briefly outlined. AIDS in the Bronx and similar areas, like tuberculosis, seems increasingly a marker disease of extreme poverty, and again like tuberculosis, seems increasingly a marker disease of extreme poverty, and again like tuberculosis, may well form an important reservoir for further spread or resurg
从人口与群落生态学、计量地理学和流行病学借鉴而来的技术，被应用于布朗克斯区的生态系统和环境指数数据，旨在了解人类免疫缺陷病毒（HIV）猖獗传播及其后遗症获得性免疫缺陷综合征（AIDS）在该行政区的起源和潜在影响：德鲁克和弗蒙德（1987年）的近期研究（《估计静脉注射吸毒率高的城市地区人类免疫缺陷病毒感染率：1987年布朗克斯区模型》，1987年6月2日在第三届国际艾滋病会议上展示的海报）估计，截至撰写本文时，布朗克斯南部25至44岁男性中的HIV血清阳性率为8%至21%，与中非城市相当。研究发现，20世纪70年代肆虐该地区、具有传染性的城市衰败的“南布朗克斯”进程及其相关的被迫人口迁移，将布朗克斯主要的HIV传播媒介静脉注射吸毒，从中部偏南布朗克斯一个地理上受限的中心扩散到几乎整个行政区范围的现象。这显著增加了控制HIV感染的难度，既因为破坏了作为教育天然载体的社会网络，也因为极大地扩大了需要密集干预的区域。由于引发“南布朗克斯”衰败的市政府“有计划收缩”的服务削减措施依然存在，且布朗克斯的住房过度拥挤程度如今已接近20世纪70年代初的水平，预计将出现新一轮传染性城市衰败，很可能再次导致人口分散，并严重损害任何现有的HIV控制策略。如果明显的艾滋病本身成为易受“南布朗克斯”进程影响的过度拥挤社区城市恶化的一个因素，那么我们可能会看到艾滋病、传染性城市衰败和人口迁移之间的非线性生态系统耦合。文中提供了基本的数学模型。因此，与中产阶级男性同性恋群体形成鲜明对比的是，在布朗克斯成功控制HIV感染，以及由此推断在其他遭受破坏的贫民区社区成功控制HIV感染，似乎取决于迅速重建人口稳定性：控制所需的工具必须首先重建。为此目的的任何项目的必要要素都作了简要概述。布朗克斯及类似地区的艾滋病，如同结核病一样，似乎越来越成为极端贫困的标志性疾病，而且很可能再次像结核病一样，成为进一步传播或死灰复燃的重要源头。
