Neighborhood Health Care Access and Sexually Transmitted Infections among Women in the Southern United States: A Cross-Sectional Multilevel Analysis

Haley, Danielle F.; Edmonds, Andrew; Belenky, Nadya; Hickson, DeMarc A.; Ramirez, Catalina; Wingood, Gina M.; Bolivar, Hector; Golub, Elizabeth; Adimora, Adaora A.

- Add this to...
- Twitter
- Facebook
- Google Bookmarks
- LinkedIn

Neighborhood Health Care Access and Sexually Transmitted Infections among Women in the Southern United States: A Cross-Sectional Multilevel Analysis

Published Date:

Jan 2018

Source:

Sex Transm Dis. 45(1):19-24

Language:

English

[PDF-84.53 KB]

Details:

Personal Authors:

Haley, Danielle F. ; Edmonds, Andrew ; Belenky, Nadya ; Hickson, DeMarc A. ; Ramirez, Catalina ; ... More ▼

Keywords:

[+]

Pubmed ID:

28876296

Pubmed Central ID:

PMC5726943

Description:

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.

Document Type:

Journal Article

Collection(s):

CDC Public Access

Funding:

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

Supporting Files:

nihms891453.nxml

text/xml

No Related Documents.

You May Also Like:

Associations Between Neighborhood Characteristics, Social Cohesion, and Perceived Sex Partner Risk among HIV-Seropositive and HIV-Seronegative Women in the Southern United States

Personal Author:

Haley, Danielle F.; Wingood, Gina M.; Kramer, Michael R.; Haardörfer, Regine; Adimora, Adaora A.; Rubtsova, Anna; Edmonds, Andrew; Goswami, Neela D.; Ludema, Christina; Hickson, DeMarc A.; Ramirez, Catalina; Ross, Zev; Bolivar, Hector; Cooper, Hannah L. F.;

Published:

Apr 25 2018

Source:

Arch Sex Behav. 47(5):1451-1463.

Description:

Neighborhood social and physical factors shape sexual network characteristics in HIV-seronegative adults in the U.S. This multilevel analysis evaluated whether these relationships also exist in a predominantly HIV-seropositive cohort of women. This c...

Public Access
Available on:

July 01, 2019
Associations between County-level Voter Turnout, County-level Felony Voter Disenfranchisement, and Sexually Transmitted Infections among Women in the Southern United States

Personal Author:

Haley, Danielle F.; Edmonds, Andrew; Schoenbach, Victor J.; Ramirez, Catalina; Hickson, DeMarc A.; Wingood, Gina M.; Bolivar, Hector; Golub, Elizabeth; Adimora, Adaora A.;

Published:

Oct 29 2018

Source:

Ann Epidemiol. 29:67-73.e1

Description:

Purpose. : Voting may play a critical role in the allocation of social and structural resources to communities, which in turn shapes neighborhood environments, and ultimately, an individual’s sexually transmitted infection (STI) risk. We assessed r...

Public Access
Available on:

January 01, 2020
Associations between Neighborhood Characteristics and Sexual Risk Behaviors among HIV-infected and HIV-uninfected Women in the Southern United States

Personal Author:

Haley, Danielle F.; Haardörfer, Regine; Kramer, Michael R.; Adimora, Adaora A.; Wingood, Gina M.; Goswami, Neela D.; Rubtsova, Anna; Ludema, Christina; Hickson, DeMarc A.; Ramirez, Catalina; Ross, Zev; Bolivar, Hector; Cooper, Hannah LF;

Published:

Apr 10 2017

Source:

Ann Epidemiol. 27(4):252-259.e1.

Description:

Introduction : 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 l...

File Type:

[PDF - 119.86 KB]
Relationships between Neighbourhood Characteristics and Current STI Status among HIV-Infected and HIV-Uninfected Women Living in the Southern United States: A Cross-Sectional Multilevel Analysis

Personal Author:

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

Published:

Mar 07 2017

Source:

Sex Transm Infect. 93(8):583-589.

Description:

Objectives : Neighbourhood characteristics (e.g., high poverty rates) are associated with sexually transmitted infections (STIs) among HIV-uninfected women in the United States (US). However, no multilevel analyses investigating the associations betw...

File Type:

[PDF - 102.29 KB]
A Multilevel Analysis of Neighborhood Socioeconomic Disadvantage and Transactional Sex with Casual Partners among Young Men Who Have Sex with Men Living in Metro Detroit

Personal Author:

Bauermeister, José A.; Eaton, Lisa; Stephenson, Rob;

Published:

2016 Jul-Sep

Source:

Behav Med. 42(3):197-204

Description:

The role of structural factors when evaluating the vulnerability of human immunodeficiency virus/sexually transmitted infection (HIV/STI) risks among young gay, bisexual, and other men who have sex with men is an important area of focus for HIV preve...

File Type:

[PDF - 126.23 KB]