Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis

Abstract

Purpose Social and economic contextual factors may promote concurrent sexual partnerships, which can accelerate population HIV/STI transmission and are more common among African Americans than U.S. Whites. We investigated the relationship between contextual factors and concurrency. Methods We analyzed past-12-month concurrency prevalence in the 2002 National Survey of Family Growth and its contextual database in relation to county sex ratio (among respondent’s racial/ethnic group), percentage in poverty (among respondent’s racial/ethnic group), and violent crime rate. Analyses examined counties with balanced (0.95–1.05 males/female) or low (<0.9) sex ratios. Results Concurrency prevalence was greater (OR; 95% CI) in counties with low sex ratios (1.67; 1.17, 2.39), more poverty (OR 1.18; 0.98, 1.42 per 10 percentage-point increase), and higher crime rates (OR 1.04; 1.00,1.09 per 1,000 population/year). Notably, 99.5% of Whites and 93.7% of Hispanics, but only 7.85% of Blacks, lived in balanced sex ratio counties; about 5% of Whites, half of Hispanics and three-fourths of Blacks resided in counties with > 20% same-race poverty. Conclusions The dramatic Black-White differences in contextual factors in the US and their association with sexual concurrency could contribute to the nation’s profound racial disparities in HIV infection.

Too many men: the violence problem?

“…For example, Angrist found that, among immigrants to the USA, high sex ratios had a large positive effect on the likelihood of female marriage and a large negative effect on female labor force participation; with men providing investment, women could avoid wage labor [37]. In general, malebiased sex ratios are associated with a greater proportion of males being married [34,38], less promiscuity in both sexes [36,39,40], and greater conjugal stability [41], all of which might contribute to the lower I s values for men shown in Box 2.…”

Venue-Based Recruitment of Women at Elevated Risk for HIV: An HIV Prevention Trials Network Study

“…Place characteristics, such as rates of poverty, violent crime, incarceration, and male to female sex ratios are thought to be powerful drivers of sexual behaviors and HIV/STI risk, particularly among U.S. black adults. [19][20][21][22][23][24][25] Past studies have used a variety of approaches to recruiting high risk women into prospective HIV cohort studies in the United States, such as peer referrals, self-referrals (e.g., flyers), and clinic-based recruitment. 6,9,[26][27][28][29] Methodologies that recruit participants from community settings may be a particularly promising approach to finding women at elevated risk of HIV and to engage them in the research process.…”

Impact of Public Housing Relocations

“…Ecologic studies suggest that STI prevalence is elevated in areas that have higher levels of poverty, social disorder, incarceration, or racial/ethnic residential segregation. e.g.,1,2 Multilevel studies of people nested in places have corroborated these ecologic findings e.g.,3-6 and have expanded exposures to include male:female sex ratios 7-9 and expanded outcomes to include sexual behaviors. e.g., 7-9 All but two of these multilevel studies, however, have been cross-sectional.…”

“…e.g.,1,2 Multilevel studies of people nested in places have corroborated these ecologic findings e.g.,3-6 and have expanded exposures to include male:female sex ratios 7-9 and expanded outcomes to include sexual behaviors. e.g., 7-9 All but two of these multilevel studies, however, have been cross-sectional. 3,8 Ecologic and cross-sectional studies have limited ability to establish causal relationships between neighborhood-level exposures and STIs.…”

“…Areas with imbalanced sex ratios may shift dyadic power dynamics in ways that promote concurrency and dense networks, and discourage condom use. 7,9,18 Residents of impoverished and socially-disordered neighborhoods have higher rates of psychological distress and substance misuse, both of which create vulnerability to engaging in sexual risk behaviors and to having riskier sexual networks. 19,20 Residents of neighborhoods with higher prevalences of STIs may be more likely to select sex partners who have an STI, since individuals often select partners from their neighborhood.…”