Towards a public health ecology: HIV /AIDS and HAART in New York City.
Item
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Title
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Towards a public health ecology: HIV /AIDS and HAART in New York City.
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Identifier
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AAI3063894
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identifier
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3063894
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Creator
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Wallace, Robert G.
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Contributor
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Advisers: Robert F. Rockwell | Carol A. Simon
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Date
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2003
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Language
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English
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Publisher
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City University of New York.
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Subject
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Health Sciences, Public Health
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Abstract
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The three papers that comprise this dissertation explore the public health ecology of HIV/AIDS and HAART in New York City from a variety of angles.;In the first paper I report the population and spatial dynamics of a contraction in New York's AIDS epidemic, during which HAART combination therapies were first introduced. I address whether the decline in AIDS incidence was homogenous across two New York boroughs, Manhattan and the Bronx, at the zip code level. 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. The paper analyzes what combinations of socioeconomic and ecological cofactors defined possible differences in AIDS decline among zip codes. Such heterogeneous geographic and social distribution in the epidemic could provide HIV refugia, areas where the virus can weather the epidemic's ebb, a troubling possibility with the accelerating microbicidal failures of HAART and the emergence of MDR-HIV.;In the second paper I model the evolution of HIV's life history and reproductive strategy in response to the combination therapies. The time-invariant stage-classified Lefkovitch population matrix model developed explores the possibility HAART can select for a semelparous life history that can evolve and invade populations of 'wildtype' iteroparous HIV. The semelparous life history includes a precocious senescence that may be embodied by an accelerated time to AIDS during the infection. In short, if such a virus evolved, HIV infections would be deadlier.;The third paper proposes a new method for analyzing and displaying epistatic change in spatial data. The method, using techniques from geometric morphometrics, is demonstrated with HIV/AIDS epidemiological data for 1990s New York. The approach captures the HIV/AIDS dynamics observed in the first paper; namely, the decline in Manhattan's epidemic was defined along a socioeconomic fault separating Lower Manhattan from Harlem, while the Bronx's decline was not so geographically distinct. The promises and problems of the technique are discussed.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
