Relationships between neighbourhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis

Abstract

Objectives Neighbourhood characteristics (e.g., high poverty rates) are associated with sexually transmitted infections (STIs) among HIV-uninfected women in the United States (US). However, no multilevel analyses investigating the associations between neighbourhood exposures and STIs have explored these relationships among women living with HIV infection. The objectives of this study were to: 1) examine relationships between neighbourhood characteristics and current STI status, and 2) investigate whether the magnitudes and directions of these relationships varied by HIV status in a predominantly HIV-infected cohort of women living in the southern US. Methods This cross-sectional multilevel analysis tests relationships between census tract characteristics and current STI status utilizing data from 737 women enrolled at the Women's Interagency HIV Study's southern sites (530 HIV-infected and 207 HIV-uninfected women). Administrative data (e.g., US Census) described the census tract-level social disorder (e.g., violent crime rate) and social disadvantage (e.g., alcohol outlet density) where women lived. Participant-level data were gathered via survey. Testing positive for a current STI was defined as a laboratory-confirmed diagnosis of chlamydia, gonorrhoea, trichomoniasis, or syphilis. Hierarchical generalized linear models were utilized to determine relationships between tract-level characteristics and current STI status, and to test whether these relationships varied by HIV status. Results Eleven percent of participants tested positive for at least one current STI. Greater tract-level social disorder (OR=1.34, 95% CI=0.99, 1.87) and social disadvantage (OR=1.34, 95% CI=0.96, 1.86) were associated with having a current STI. There was no evidence of additive or multiplicative interaction between tract-level characteristics and HIV status. Conclusions Findings suggest that neighbourhood characteristics may be associated with current STIs among women living in the South, and that relationships do not vary by HIV status. Future research should establish the temporality of these relationships and explore pathways through which neighbourhoods create vulnerability to STIs.

Associations between neighborhood characteristics and sexual risk behaviors among HIV-infected and HIV-uninfected women in the southern United States

“…The direction of this relationship was unexpected. Elements of our neighborhood disorder component, including STI prevalence and violent crime, are associated with partner concurrency, STI acquisition, and greater perceived sexual partner risk [16, 37, 38]. It is possible that women living in neighborhoods with greater social disorder perceived their partners to be riskier, and that these perceptions discouraged engaging in AI or promoted condom use during AI [39–41].…”

Associations between county-level voter turnout, county-level felony voter disenfranchisement, and sexually transmitted infections among women in the Southern United States

“…5–8, 15, 28 Measures of county socioeconomic advantage (i.e., median household income, percentage of residents 25 or older with a college degree or greater, and percentage of residents over age 16 who were employed) were created using ACS 2010–2014 5-year estimates. Because these socioeconomic measures were correlated, we used principal component analysis (PCA) with orthogonal rotation (varimax) to capture underlying constructs and avoid multicollinearity.…”

HIV-related sexual decisions made by African-American adolescents living in different family structures: study from an ecodevelopmental perspective

“…The concentrated disadvantage and housing instability are associated with less social cohesion resulting in more crime and violence in the neighborhood, 23 as well as adolescents’ early sexual initiation, 24 lower condom use, 25 and higher rates of STIs. 26 …”