Background: Geographic areas with high levels of poverty and social disorder tend to have high prevalences of sexually transmitted infections (STIs). This multilevel analysis tests relationships between census tract-level characteristics and the odds of testing positive for a current STI in a predominantly HIV-infected cohort of women living in the southern United States (US).
Methods: This cross-sectional multilevel analysis included data from 737 HIV-infected and HIV-uninfected women enrolled at the Women’s Interagency HIV Study’s southern sites. Administrative data (e.g., US Census) captured characteristics of the census tracts where women lived (e.g., percent unemployed residents); individual-level data (e.g., sexual behaviors) were gathered via survey. We used principal components analysis with orthogonal rotation (varimax) to condense tract-level variables into components capturing underlying constructs: social disorder (i.e., violent crime rate, percent vacant housing, percent unemployed residents, and percent residents in poverty) and social disadvantage (e.g., alcohol outlet density and percent renter-occupied housing). Testing positive for a current STI was defined as a laboratory-confirmed diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, or treponema pallidum. We used hierarchical generalized linear models to determine relationships between tracts and a current STI status and to test whether these relationships varied by HIV status.
Results: Eleven percent of participants tested positive for at least one STI. Greater tract-level social disorder (OR=1.34, 95% CI=0.99, 1.87; p=0.06) and social disadvantage (OR=1.34, 95% CI=0.96, 1.86; p=0.08) were borderline statistically significantly associated with testing positive for an STI. There was no evidence of additive or mulitplicative interaction between tract characteristics and HIV status.
Conclusions: Findings suggest that neighborhood 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 the pathways through which neighborhoods create vulnerability to STIs.