Associations between neighborhood characteristics and sexual risk behaviors among HIV-infected and HIV-uninfected women in the southern United States

• Type of Material: Article
• Authors: Danielle F. Haley, Emory University; Regine Haardoerfer, Emory University; Michael R Kramer, Emory University; Adaora A. Adimora, University of North Carolina at Chapel Hill; Gina M. Wingood, Columbia University; Neela Goswami, Emory University; Anna Rubtsova, Emory University; Christina Ludema, University of North Carolina; DeMarc A. Hickson, Jackson State University; Catalina Ramirez, University of North Carolina; Zev Ross, Zev Ross Spatial Analysis; Hector Bolivar, University of Miami; Hannah Cooper, Emory University
• Language: English
• Date: 2017-04-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.annePidem.2017.03.004
• Title of Journal or Parent Work: Annals of Epidemiology
• ISSN: 1047-2797
• Volume: 27
• Issue: 4
• Start Page: 252
• End Page: 259
• Grant/Funding Information: The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases, with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Mental Health.; Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Deafness and other Communication Disorders, and the National Institutes of Health Office of Research on Women’s Health.; This work was supported by the National Institute of Mental Health of the National Institutes of Health [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 & Human Development of the National Institutes of Health [K01HD074726], and the Centers for Disease Control and Prevention [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 [U01-AI-103401] Principal Investigators (PIs): Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker; Atlanta WIHS [U01-AI-103408] PIs: Ighovwerha Ofotokun and Gina Wingood; Miami WIHS [U01-AI-103397] PIs: Margaret Fischl and Lisa Metsch; UNC WIHS [U01-AI-103390] PI: Adaora Adimora; WIHS Data Management and Analysis Center [U01-AI-042590] PIs: Stephen Gange and Elizabeth Golub.; WIHS data collection is also supported by UL1-TR000454 (Atlanta CTSA).
• Keywords: MULTILEVEL ANALYSIS; Science & Technology; TRANSMITTED INFECTIONS; PUBLIC-HOUSING RELOCATIONS; ALCOHOL OUTLETS; Public, Environmental & Occupational Health; INCARCERATION RATES; Sexual behavior; Multilevel analysis; HIV; Life Sciences & Biomedicine; GONORRHEA; PARTNERS; ANAL INTERCOURSE; Women; Residence characteristics; LONGITUDINAL ANALYSIS; INTERAGENCY HIV
• Research Categories: Health Sciences, Epidemiology; Biology, Biostatistics; Health Sciences, Public Health

Abstract

Purpose Neighborhood characteristics shape sexual risk in HIV-uninfected adults in the United States (US). We assess relationships between census tract 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 women enrolled in the Women's Interagency HIV Study. Administrative data captured characteristics of census tracts where women lived; participant-level data were gathered via survey. We used principal components analysis to condense tract-level variables into components: social disorder (e.g., violent crime rate), and social disadvantage (e.g., alcohol outlet density). We used hierarchical generalized linear models to assess relationships between tract-level characteristics and condomless vaginal intercourse, anal intercourse, and condomless anal intercourse. Results Greater social disorder was associated with less anal intercourse (OR = 0.63, 95% CI = 0.43–0.94) and condomless anal intercourse (OR = 0.49, 95% CI = 0.30–0.80), regardless of HIV status. There were no statistically significant additive or multiplicative interactions between tract characteristics and HIV status. Conclusions Neighborhood characteristics are associated with sexual risk behaviors among women living in the Southern US, these relationships do not vary by HIV status. Future studies should establish temporality and explore the causal pathways through which neighborhoods influence sexual risk.