title: Relationships between neighbourhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis.
abstract: Neighbourhood characteristics (eg, high poverty rates) are associated with STIs among HIV-uninfected women in the USA. However, no multilevel analyses investigating the associations between neighbourhood exposures and STIs have explored these relationships among women living with HIV infection. The objectives of this study were to: (1) examine relationships between neighbourhood characteristics and current STI status and (2) investigate whether the magnitudes and directions of these relationships varied by HIV status in a predominantly HIV-infected cohort of women living in the Southern USA.
  
  
  
  This cross-sectional multilevel analysis tests relationships between census tract characteristics and current STI status using data from 737 women enrolled at the Women's Interagency HIV Study's southern sites (530 HIV-infected and 207 HIV-uninfected women). Administrative data (eg, US Census) described the census tract-level social disorder (eg, violent crime rate) and social disadvantage (eg, alcohol outlet density) where women lived. Participant-level data were gathered via survey. Testing positive for a current STI was defined as a laboratory-confirmed diagnosis of chlamydia, gonorrhoea, trichomoniasis or syphilis. Hierarchical generalised linear models were used to determine relationships between tract-level characteristics and current STI status, and to test whether these relationships varied by HIV status.
  
  
  
  Eleven per cent of participants tested positive for at least one current STI. Greater tract-level social disorder (OR=1.34, 95% CI 0.99 to 1.87) and social disadvantage (OR=1.34, 95% CI 0.96 to 1.86) were associated with having a current STI. There was no evidence of additive or multiplicative interaction between tract-level characteristics and HIV status.
  
  
  
  Findings suggest that neighbourhood characteristics may be associated with current STIs among women living in the South, and that relationships do not vary by HIV status. Future research should establish the temporality of these relationships and explore pathways through which neighbourhoods create vulnerability to STIs.
  
  
  
  NCT00000797; results.
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, Georgia, USA.|Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Danielle F
authors.identifier: 0000-0002-4281-2731
authors.initials: DF
authors.lastname: Haley
authors.affiliation: Department of Epidemiology, Rollins School of Public Health at Emory University, Atlanta, Georgia, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kramer
authors.affiliation: Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA.|Department of Epidemiology, UNC Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, Georgia, USA.
authors.forename: Regine
authors.initials: R
authors.lastname: Haardörfer
authors.affiliation: Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health at Columbia University, New York, New York, USA.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Wingood
authors.affiliation: Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Ludema
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, Georgia, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Rubtsova
authors.affiliation: Department of Epidemiology and Biostatistics, Jackson State University School of Public Health, Jackson, Mississippi, USA.
authors.forename: DeMarc A
authors.initials: DA
authors.lastname: Hickson
authors.affiliation: ZevRoss Spatial Analysis, Ithaca, New York, USA.
authors.forename: Zev
authors.initials: Z
authors.lastname: Ross
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Golub
authors.affiliation: Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Hector
authors.initials: H
authors.lastname: Bolivar
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, Georgia, USA.
authors.forename: Hannah Lf
authors.initials: HL
authors.lastname: Cooper
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055361:Multilevel Analysis; D012111:Residence Characteristics; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D012923:Social Class; D015206:Southwestern United States / Q000453:epidemiology; D016387:Women's Health
keywords: EPIDEMIOLOGY (GENERAL); HIV; INFECTIOUS DISEASES; SEXUAL HEALTH; WOMEN