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Author Notes:

Corresponding Author: Loida E. Bonney, MD, MPH, Department of Medicine, Emory University School of Medicine and Center for AIDS Research, Emory University, 49 Jessie Hill Junior Drive SE, Atlanta, GA 30303, Phone: 404-778-1620, Fax: 404-778-1601, lbonney@emory.edu


Research Funding:

This study was funded by Emory Center for AIDS Research (P30 AI050409), National Institutes of Health NIDA (R21DA027072) and NIDA (R01DA029513).


  • health disparities
  • access to care
  • sexually transmitted infections

Access to health services and sexually transmitted infections in a cohort of relocating African American public housing residents: An association between travel time and infection


Journal Title:

Sexually Transmitted Diseases


Volume 39, Number 2


, Pages 116-121

Type of Work:

Article | Post-print: After Peer Review


Background High incidence and prevalence of sexually transmitted infection (STI) in African Americans have been attributed to multiple factors. However, few articles have discussed spatial access to healthcare as a driver of disparities. The objective of this analysis was to evaluate the relationship between travel time to a healthcare provider and the likelihood of testing positive for one of three STIs in a sample of adults living in public housing. Methods One hundred and eight African-American adults in Atlanta, Georgia from November 2008 – June 2009, completed a survey that queried sexual behavior and healthcare utilization and had urine tested for, C. trachomatis, N. gonorrhoeae, and T. vaginalis by molecular methods. Travel time was a continuous variable capturing the number of minutes it took to reach the place where participants received most of their care. Multivariate analyses tested the hypothesis that individuals reporting longer travel times would be more likely to test positive for an STI. Travel time was squared to linearize its relationship to the outcome. Results Thirty six residents (37.5%) tested positive for ≥1 STI. A curvilinear relationship existed between travel time and STI status. When travel time was <48 minutes, a positive relationship existed between travel time and the odds of testing positive for an STI. An inverse relationship existed when travel time was ≥48 minutes. Conclusion Residents of impoverished communities experience a curvilinear relationship between travel time and STI status. We discuss possible factors that might have created this curvilinear relationship including voluntary social isolation.

Copyright information:

© 2012 American Sexually Transmitted Diseases Association

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