The Spatiotemporal Dynamics of AIDS and TB in the New York Metropolitan Region from a Sociogeographic Perspective: Understanding the Linkages of Central City and Suburbs

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Abstract
Empirical and theoretical analyses based on observed patterns of incidence of AIDS and tuberculosis, on rates of poverty, and on statistics describing a ‘Markov infection’ driven by the ‘commuting field’ around Manhattan, strongly suggest that urban and suburban epicenters within a twenty-four-county metropolitan region, covering eighteen million people and more than 7600 square miles, may be significantly and increasingly linked to outlying affluent areas through a process driven by fundamental social, geographic, and economic structures. AIDS and TB rates outside the epicenter of New York City are found to display similar patterns of spread in space and time, and have been strongly coupled to rates of infection within it for some time, a circumstance which will continue and may intensify as ‘heterosexual AIDS’ becomes more predominant and as multiple drug-resistant forms of TB evolve within disintegrating inner city minority communities. The work reported here, involving a relatively large area and a high population, strongly contradicts the findings of a recent National Research Council report on the social impact of AIDS, which, based on a severely constrained scale of analysis, concluded that the concentration of disease within marginalized urban communities implies many geographical areas and strata of the population are and will remain untouched by the AIDS epidemic. The hyperconcentration of infection in urban epicenters is not containment, but rather a principal force behind further spread. This work, in part a technology transfer from community ecology of ideas on refugia and reservoirs, adds significantly to a growing body of evidence which strongly implies that wide-spread urban reform is an essential, but largely unrecognized, component for any realistic national programs to control AIDS, multiple-drug-resistant TB, and other infectious diseases.