28876296

PMC5726943

Introduction

The United States (US) has experienced an increase in reportable sexually transmitted infections (STIs) while simultaneously experiencing a decline in safety net services for STI testing and treatment. This multilevel study assessed relationships between neighborhood-level access to health care and STIs among a predominantly HIV-seropositive cohort of women living in the South.

Methods

This cross-sectional multilevel analysis included baseline data from HIV-seropositive and HIV-seronegative women enrolled in the Women’s Interagency HIV Study sites in Alabama, Florida, Georgia, Mississippi, and North Carolina between 2013 and 2015 (N=666). Administrative data (e.g., US Census) described health care access (e.g., percentage of residents with a primary care provider, percentage of residents with health insurance) in the census tracts where women lived. STIs (chlamydia, gonorrhea, trichomoniasis, or early syphilis) were diagnosed using laboratory testing. Generalized estimating equations were used to determine relationships between tract-level characteristics and STIs. Analyses were conducted using SAS 9.4.

Results

Seventy percent of participants were HIV-seropositive. Eleven percent of participants had an STI. A four-unit increase in the percentage of residents with a primary care provider was associated with 39% lower STI risk (RR=0.61, 95% CI=0.38–0.99). The percentage of tract residents with health insurance was not associated with STIs (RR=0.98, 95% CI=0.91–1.05). Relationships did not vary by HIV status.

Conclusions

Greater neighborhood health care access was associated with fewer STIs. Research should establish the causality of this relationship and pathways through which neighborhood health care access influences STIs. Structural interventions and programs increasing linkage to care may reduce STIs.

CDC Public Access

U01 AI103397/AI/NIAID NIH HHS/United States
U01 PS003315/PS/NCHHSTP CDC HHS/United States
UL1 TR000454/TR/NCATS NIH HHS/United States
U01 AI103401/AI/NIAID NIH HHS/United States
U01 AI103390/AI/NIAID NIH HHS/United States
U01 AI103408/AI/NIAID NIH HHS/United States
P30 AI050410/AI/NIAID NIH HHS/United States
U01 AI042590/AI/NIAID NIH HHS/United States
U01 PS003315/PS/NCHHSTP CDC HHS/United States