Background: Research suggests that neighborhood characteristics shape sexual risk in HIV-uninfected adults in the United States (US). This multilevel analysis tests relationships between census tract-level characteristics and sexual risk behaviors in a predominantly HIV-infected cohort of women living in the Southern US.
Methods: This cross-sectional multilevel analysis included data from 737 HIV-infected and HIV-uninfected high-risk women enrolled in the Women’s Interagency HIV Study’s southern sites in Alabama, Florida, Georgia, Mississippi, and North Carolina. Administrative data (e.g., US Census) captured characteristics of the census tracts where women lived (e.g., percent unemployed residents); individual-level data 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). We used hierarchical generalized linear models to assess relationships between census tract characteristics and unprotected vaginal intercourse (UVI), anal intercourse (AI), and unprotected anal intercourse (UAI), and to test whether these relationships varied by HIV status.
Results: On average, participants lived in census tracts with 29% of residents living in poverty (SD=13.65) and where roughly half of housing units were renter-occupied (SD=21.73). Greater social disorder was associated with a lower odds of AI (OR=0.65, 95% CI=0.43, 0.96) and UAI (OR=0.50, 95% CI=0.31, 0.82) regardless of HIV status. Tract-level social disadvantage was not associated with sexual risk behaviors. There were no statistically significant additive or multiplicative interactions between tract characteristics and HIV status.
Conclusions: Study findings reveal that neighborhood characteristics are associated with sexual risk behaviors among women living in the South and that these relationships do not vary by HIV status. Future studies should establish temporal relationships and explore the pathways through which neighborhoods influence sexual behaviors.