Objectives Neighbourhood characteristics (eg, high poverty rates) are associated with STIs among HIV-uninfected women in the USA. 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 USA.
Methods This cross-sectional multilevel analysis tests relationships between census tract characteristics and current STI status using 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 (eg, US Census) described the census tract-level social disorder (eg, violent crime rate) and social disadvantage (eg, 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 generalised linear models were used to determine relationships between tract-level characteristics and current STI status, and to test whether these relationships varied by HIV status.
Results Eleven per cent of participants tested positive for at least one current STI. Greater tract-level social disorder (OR=1.34, 95% CI 0.99 to 1.87) and social disadvantage (OR=1.34, 95% CI 0.96 to 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.
Trial registration number NCT00000797; results.
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Handling editor Jackie A Cassell
Contributors DFH designed the study; acquired, analysed and interpreted study data, led manuscript development and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MRK, RH and HLFC contributed to study design, analysis, interpretation of study data and revised the work critically for important intellectual content. AAA and GMW contributed to study design, data acquisition, interpretation of study data and revised the work critically for important intellectual content. AR and CL contributed to data acquisition and revised the work critically for important intellectual content. ZR contributed to data analysis and revised the work critically for important intellectual content. DAH, EG and HB revised the work critically for important intellectual content. All authors provided final approval of the version to be published.
Funding This work was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number F31MH105238, the Surgeon General C Everett Koop HIV/AIDS Research Grant, the George W Woodruff Fellowship of the Laney Graduate School, the Emory Center for AIDS Research (P30 AI050409), the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under Award Number K01HD074726 and the Centers for Disease Control and Prevention under Cooperative Agreement U01PS003315 as part of the Minority HIV/AIDS Research Initiative. Participant data in this manuscript were collected by the Women's Interagency HIV Study (WIHS): UAB-MS WIHS (PIs: Michael Saag, Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (PIs: Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Miami WIHS (PIs: Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (PI: Adaora Adimora) U01-AI-103390; WIHS Data Management and Analysis Center (PIs: Stephen Gange and Elizabeth Golub) U01-AI-042590. The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA) and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD) and the NIH Office of Research on Women's Health. WIHS data collection is also supported by UL1-TR000454 (Atlanta CTSA).
Disclaimer The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health. The NC Department of Health and Human Services does not take responsibility for the scientific validity or accuracy of methodology, results, statistical analyses or conclusions presented.
Competing interests None declared.
Ethics approval Emory University IRB (IRB00062469).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There are no additional unpublished data available. Readers should contact DFH with any inquiries.
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