When There's Nothing To Do, You Do Somebody: Environmental Factors Affecting HIV Risk in Rural North Carolina

Background:
Project GRACE uses a community-based participatory research approach to understand contextual factors affecting HIV risk among African Americans in two rural North Carolina counties.

Objective:
To explore rural African American's perceptions of environmental factors that contribute to HIV risk in their community.

Method:
We conducted 11 focus groups with 94 rural African Americans aged 14-22 in 2006. The groups were audio-taped, transcribed and entered into Altas.ti. Thematic coding was performed using a grounded theory approach and 3 independent coders.

Result:
Participants described a general lack of recreational opportunities in the community, particularly for adolescents aged 14-22 and noted a relationship between this lack of recreational opportunities and sexual activities. Three key themes emerged as environmental factors influencing HIV risk within the community: an absence of indoor and outdoor recreational environments, a paucity of diverse dating options and few safe environments for socializing. Gang violence and longstanding conflict between communities created unsafe recreational environments, fueled fights when people congregate socially and limited leisure time options by restricting people's activities to their neighborhoods. Barriers to using the few recreational opportunities that do exist include prohibitive membership or entrance fees and facilities that are neither well-maintained nor adequately supervised. In the absence of options for adolescent socializing, local hotels provide space for youth parties that are rarely chaperoned by responsible adults and often provide access to drugs and unsafe sex.

Conclusion:
Deficiencies in the built environment and community program planning are important contributors to sexual activity. Coupled with other individual and interpersonal risk behaviors, environmental factors may help fuel the HIV epidemic. Providing safe and diverse recreational opportunities, particularly for adolescents and young adults, represents a public health approach to HIV risk reduction.

Implications:
Locales should assess the adequacy of their recreational programs and facilities, particularly for youth, as a means of reducing boredom and sexual opportunities.