Structural factors shape racial differences in neighbourhood-level HIV risk environments for young men who have sex with men.

Despite lower or comparable rates of individual HIV risk behaviours, Black young men who have sex with men in the USA experience disproportionately high rates of HIV. This calls for the exploration of network- and neighbourhood-level determinants of HIV vulnerabilities. Research highlights how Black young men who have sex with men are more likely to reside in low-resource neighbourhoods, to be affiliated with a broader range of neighbourhoods, and to be embedded in densely connected, racially homophilous sexual networks. Using a risk environments framework, this study examines how structural factors (such as racial segregation, resource inequality, poverty, community violence, and racist policing) influence the neighbourhood characteristics affecting Black, Latino, and White young men who have sex with men in Chicago. In turn, neighbourhood-level factors may drive racial disparities in HIV by influencing the consequences of individual risk behaviours. This study suggests that addressing these disparities by targeting the structural factors that shape risk environments is important in reducing HIV-related risk. It contributes to a growing body of work calling for multilevel, equity-focused approaches to HIV prevention among young men who have sex with men in the USA.