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 L F
Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA; Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill.
Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA.
Ann Epidemiol. 2017 Apr;27(4):252-259.e1. doi: 10.1016/j.annepidem.2017.03.004. Epub 2017 Apr 10.
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 living in the Southern US.
This cross-sectional multilevel analysis included data from 737 HIV-infected and HIV-uninfected women enrolled in the Women's Interagency HIV Study. Administrative data captured characteristics of census tracts where women lived; participant-level data were gathered via survey. We used principal components analysis to condense tract-level variables into components: social disorder (e.g., violent crime rate), and social disadvantage (e.g., alcohol outlet density). We used hierarchical generalized linear models to assess relationships between tract-level characteristics and condomless vaginal intercourse, anal intercourse, and condomless anal intercourse.
Greater social disorder was associated with less anal intercourse (OR = 0.63, 95% CI = 0.43-0.94) and condomless anal intercourse (OR = 0.49, 95% CI = 0.30-0.80), regardless of HIV status. There were no statistically significant additive or multiplicative interactions between tract characteristics and HIV status.
Neighborhood characteristics are associated with sexual risk behaviors among women living in the Southern US, these relationships do not vary by HIV status. Future studies should establish temporality and explore the causal pathways through which neighborhoods influence sexual risk.
在美国，社区特征塑造了未感染艾滋病毒成年人的性风险。我们评估了美国南部一个以感染艾滋病毒女性为主的队列中，普查区特征与性风险行为之间的关系。
这项横断面多层次分析纳入了参与妇女机构间艾滋病毒研究的737名感染艾滋病毒和未感染艾滋病毒的女性的数据。行政数据记录了女性居住的普查区的特征；通过调查收集参与者层面的数据。我们使用主成分分析将普查区层面的变量浓缩为几个成分：社会失序（例如暴力犯罪率）和社会劣势（例如酒类销售点密度）。我们使用分层广义线性模型来评估普查区层面特征与无保护阴道性交、肛交和无保护肛交之间的关系。
无论艾滋病毒感染状况如何，更大程度的社会失序与较少的肛交（比值比=0.63，95%置信区间=0.43-0.94）和无保护肛交（比值比=0.49，95%置信区间=0.30-0.80）相关。普查区特征与艾滋病毒感染状况之间没有统计学上显著的相加或相乘交互作用。
美国南部女性的社区特征与性风险行为相关，这些关系不因艾滋病毒感染状况而有所不同。未来的研究应确定时间顺序，并探索社区影响性风险的因果途径。
