Neighborhood Factors, Sexual Risk Behaviors, Sex Partner Risk, and Sexually Transmitted Infections among HIV-Infected and High Risk HIV-Uninfected Women in the Southern United States Público

Abstract

Neighborhood characteristics shape sexual risk and sexually transmitted infections (STIs) in HIV-uninfected adults in the United States (US). This dissertation utilizes multilevel analyses to test relationships between census tract characteristics and sexual risk behaviors, sex partner risk, and testing positive for an STI in a predominantly HIV-infected cohort of women living in the southern US. Methods. This cross-sectional multilevel study analyzed 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; individual-level data were gathered via survey. We used principal components analysis to condense tract-level variables into two components: social disorder (e.g., violent crime rate) and social disadvantage (e.g., alcohol outlet density). We used hierarchical generalized linear models to test relationships between tract characteristics and (1) sexual risk behaviors (unprotected vaginal intercourse [UVI], anal intercourse [AI], unprotected anal intercourse [UAI]); (2) sex partner characteristics (risk-level [e.g., lifetime history of injection drug use], non-monogamy); and (3) testing positive for a current STI (Chlamydia, gonorrhea, trichomoniasis, syphilis) and to assess whether these relationships varied by HIV status. Results. Greater tract-level social disorder was associated with less 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; less partner non-monogamy (OR=0.72, 95% CI=0.54, 0.96) among HIV-uninfected women; and greater partner non-monogamy (OR=1.20, 95% CI=0.96, 1.50) and partner risk (OR=1.41, 95% CI= 1.16, 1.72) among HIV-infected women. Greater tract-level social disorder was associated with more STIs (OR=1.34, 95% CI=0.99, 1.87), regardless of HIV status. Greater social disadvantage was associated with less partner non-monogamy (OR=0.73 95% CI=0.60, 0.96) and lower partner risk (OR=0.84, 95% CI=0.72, 0.97), but more STIs (OR=1.34, 95% CI=0.96, 1.86), regardless of HIV status. Perceived neighborhood cohesion was associated with lower partner risk (OR=0.84, 95% CI=0.70, 1.02), regardless of HIV status. Conclusion. Findings suggest that neighborhood characteristics may be associated with sexual behaviors, partner characteristics, and STIs among HIV infected and HIV uninfected Southern women. Future research should establish the temporality of relationships and explore pathways through which neighborhoods create vulnerability to STIs.

Table of Contents

Chapter 1: Introductory Literature Review

Introduction 1

Neighborhood-Level Determinants of Sexual Behavior and HIV/STIs 1

Potential Mechanisms through which Neighborhood-Level Determinants Influence Sexual Behavior and HIV/STIs 2

Limitations in our Understanding of Whether and How Neighborhood- Level Determinants Influence Sexual Behavior and STIs among HIV-Infected Women 3

Significance of the Research 5

Figure 8

References 9

Chapter 2: Associations between Neighborhood Characteristics and Perceived Sex Partner Risk among HIV-infected and HIV-uninfected Women in the Southern United States

Abstract 17

Introduction 19

Methods 21

Results 28

Discussion 33

Tables 39

References 45

Chapter 3: Associations between Neighborhood Characteristics and Sexual Risk Behaviors among HIV-infected and HIV-uninfected Women in the Southern United States

Abstract 54

Introduction 56

Methods 58

Results 64

Discussion 67

Tables 71

References 77

Chapter 4: Do Relationships between Neighborhood Characteristics and Current STI Status among Women Vary by HIV Status?

Abstract 85

Introduction 87

Methods 88

Results 93

Discussion 96

Tables 100

References 107

Chapter 5: Summary and Conclusion

Introduction 115

Summary of Key Findings 115

Strengths and Limitations 120

Directions for Future Research 122

Conclusion 126

Figure 128

References 129

About this Dissertation

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School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health Psychology, Behavioral
Palabra Clave	HIV-infected women Neighborhood characteristics Sexually transmitted infections
Committee Chair / Thesis Advisor	Cooper, Hannah, Emory University
Committee Members	Kramer, Michael R, Emory University Wingood, Gina M, Emory University Haardoerfer, Regine, Emory University Adimora, Adaora, University of North Carolina

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