TY - JOUR
T1 - Neighborhood Health Care Access and Sexually Transmitted Infections among Women in the Southern United States
T2 - A Cross-Sectional Multilevel Analysis
AU - Haley, Danielle F.
AU - Edmonds, Andrew
AU - Belenky, Nadya
AU - Hickson, De Marc A.
AU - Ramirez, Catalina
AU - Wingood, Gina M.
AU - Bolivar, Hector
AU - Golub, Elizabeth
AU - Adimora, Adaora A.
N1 - Funding Information:
Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Miami WIHS (PIs: Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (PI: Adaora Adimora) U01-AI-103390; WIHS Data Management and Analysis Center (PIs: Stephen Gange and Elizabeth Golub) U01-AI-042590. Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Deafness and other Communication Disorders, and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000454 (Atlanta CTSA). DAH’s time was supported by the Centers for Disease Control and Prevention under Cooperative Agreement U01PS003315 as part of the Minority HIV/AIDS Research Initiative. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health.
Publisher Copyright:
© Copyright 2017 American Sexually Transmitted Diseases Association. All rights reserved.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Introduction: The United States 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 Human Immunodeficiency Virus (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 (eg, United States Census) described health care access (eg, percentage of residents with a primary care provider, percentage of residents with health insurance) in the census tracts where women lived. Sexually transmitted infections (chlamydia, gonorrhea, trichomoniasis, or early syphilis) were diagnosed using laboratory testing. Generalized estimating equations were used to determine relationships between tractlevel 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 4-unit increase in the percentage of residents with a primary care provider was associated with 39% lower STI risk (risk ratio, 0.61, 95%confidence interval, 0.38-0.99). The percentage of tract residents with health insurance was not associated with STIs (risk ratio, 0.98, 95% confidence interval, 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.
AB - Introduction: The United States 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 Human Immunodeficiency Virus (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 (eg, United States Census) described health care access (eg, percentage of residents with a primary care provider, percentage of residents with health insurance) in the census tracts where women lived. Sexually transmitted infections (chlamydia, gonorrhea, trichomoniasis, or early syphilis) were diagnosed using laboratory testing. Generalized estimating equations were used to determine relationships between tractlevel 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 4-unit increase in the percentage of residents with a primary care provider was associated with 39% lower STI risk (risk ratio, 0.61, 95%confidence interval, 0.38-0.99). The percentage of tract residents with health insurance was not associated with STIs (risk ratio, 0.98, 95% confidence interval, 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.
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U2 - 10.1097/OLQ.0000000000000685
DO - 10.1097/OLQ.0000000000000685
M3 - Article
C2 - 28876296
AN - SCOPUS:85038579914
SN - 0148-5717
VL - 45
SP - 19
EP - 24
JO - Sexually transmitted diseases
JF - Sexually transmitted diseases
IS - 1
ER -