Relationships between neighbourhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA

A cross-sectional multilevel analysis

Danielle F. Haley, Michael R. Kramer, Adaora A. Adimora, Regine Haardörfer, Gina M. Wingood, Christina Ludema, Anna Rubtsova, De Marc A. Hickson, Zev Ross, Elizabeth Golub, Hector Bolivar, Hannah L.F. Cooper

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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 HIVuninfected 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.

Original languageEnglish (US)
JournalSexually Transmitted Infections
DOIs
StateAccepted/In press - Mar 7 2017

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Multilevel Analysis
Sexually Transmitted Diseases
Cross-Sectional Studies
HIV
Censuses
Chlamydia
Gonorrhea
Clinical Laboratory Techniques
Crime
Syphilis
Poverty
HIV Infections
Linear Models
Alcohols

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

Cite this

Relationships between neighbourhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA : A cross-sectional multilevel analysis. / Haley, Danielle F.; Kramer, Michael R.; Adimora, Adaora A.; Haardörfer, Regine; Wingood, Gina M.; Ludema, Christina; Rubtsova, Anna; Hickson, De Marc A.; Ross, Zev; Golub, Elizabeth; Bolivar, Hector; Cooper, Hannah L.F.

In: Sexually Transmitted Infections, 07.03.2017.

Research output: Contribution to journalArticle

Haley, Danielle F. ; Kramer, Michael R. ; Adimora, Adaora A. ; Haardörfer, Regine ; Wingood, Gina M. ; Ludema, Christina ; Rubtsova, Anna ; Hickson, De Marc A. ; Ross, Zev ; Golub, Elizabeth ; Bolivar, Hector ; Cooper, Hannah L.F. / Relationships between neighbourhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA : A cross-sectional multilevel analysis. In: Sexually Transmitted Infections. 2017.
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abstract = "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 HIVuninfected 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.",
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T1 - Relationships between neighbourhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA

T2 - A cross-sectional multilevel analysis

AU - Haley, Danielle F.

AU - Kramer, Michael R.

AU - Adimora, Adaora A.

AU - Haardörfer, Regine

AU - Wingood, Gina M.

AU - Ludema, Christina

AU - Rubtsova, Anna

AU - Hickson, De Marc A.

AU - Ross, Zev

AU - Golub, Elizabeth

AU - Bolivar, Hector

AU - Cooper, Hannah L.F.

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N2 - 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 HIVuninfected 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.

AB - 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 HIVuninfected 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.

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