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

Details

• Alternative Title:
  Sex Transm Dis
• Personal Author:
  Haley, Danielle F. ; Edmonds, Andrew ; Belenky, Nadya ; Hickson, DeMarc A. ; Ramirez, Catalina ; Wingood, Gina M. ; Bolivar, Hector ; Golub, Elizabeth ; Adimora, Adaora A.
• 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.
  
  
• Subjects:
  Adult Cross-Sectional Studies Educational Status Ethnicity Female Health Knowledge, Attitudes, Practice Health Services Accessibility Humans Middle Aged Multilevel Analysis Patient Acceptance Of Health Care Residence Characteristics Sexual Behavior Sexually Transmitted Diseases Women's Health Young Adult

  More +
• Source:
  Sex Transm Dis. 45(1):19-24
• Pubmed ID:
  28876296
• Pubmed Central ID:
  PMC5726943
• Document Type:
  Journal Article
• 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
• Place as Subject:
  Southwestern United States
• Volume:
  45
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:27fa270e3987e5ee93b2b54f0b99ed863f1490a443c4127d0ef115a48223b8f7
• Download URL:
  https://stacks.cdc.gov/view/cdc/50527/cdc_50527_DS1.pdf
• File Type:
  [PDF - 84.53 KB ]