Are Neighborhood Sociocultural Factors Influencing the Spatial Pattern of Gonorrhea in North Carolina?

Abstract

Sexually transmitted infections (STIs) tend to cluster in geographically definable core areas, or risk spaces.(1-15) These core areas are often located in low socioeconomic status (SES) urban neighborhoods, (4,7,9,16,17) suggesting that socio-cultural determinants of health may influence the clustered spatial pattern observed for STIs.Several socio-cultural risk factors have been associated with gonorrhea in urban environments including individual level factors such as SES and community level (e.g. county or state) factors such as prevalence of infection,(18) % urbanicity,(19) neighborhood instability,(20) gender imbalance with more women than men, low social capital, (21,22) and high % Black or Hispanic.(5,23) For instance, low SES can impair timely access to STI services, thereby increasing the duration of infection and ultimately the prevalence of infection within a sexual network. Prevalence of an STI has a direct impact on the incidence of infection. As STI prevalence increases, the likelihood of finding a sexual partner that has an STI also increases. The power to negotiate the terms and conditions around sex is affected by both an imbalanced sex ratio, and the proportion of single parents in a Corresponding Author: Dionne Gesink, University of Toronto, Dalla Lana School of Public Health, 155 College St, 6 th Floor, Toronto, Ontario, M5T 3M7, Canada, dionne.gesink@utoronto.ca,. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Rurality may influence STI transmission through the low density and availability of partners within a sexual network, as well as the culture and social norms around sex and relationships within a community. Rurality may also act as a proxy for low physician density, poor access to STI health services, or community racial/ethnic homogeneity and hence, partner STI prevalence. NIH Public AccessRace/ethnicity itself is not causally associated with STIs,(27) however, it can provide strong predictive power of STI risk.(28-33) For instance, in North Carolina, racial/ethnic differences in gonorrhea rates have persisted over time (18,29) suggesting that race/ethnicity is a proxy for other STI risk factors. Possible explanatory factors include partner STI prevalence, assortative mixing, historic segregation, racism, unequal access to healthcare, or high incarceration rates. (18,29,32,34) Our primary objective was to determine if the spatial pattern of gonorrhea observed for North Carolina (NC) was influenced by neighbourhood-level socio-cultural determinants of health ( Figure 1). A secondary objective was to investigate the influence of race/ethnicity o...

Ecological analysis examining the association between census tract-level incarceration and reported chlamydia incidence among female adolescents and young adults in San Francisco

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Influence of Detection Method and Study Area Scale on Syphilis Cluster Identification in North Carolina

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Attitudes Toward and Sexual Partnerships With Drug Dealers Among Young Adult African American Females in Socially Disorganized Communities

“…In particular, there is a growing base of literature suggesting that sexual partner characteristics, which are influenced by social and economic factors, may be important contributing factors to the disproportionately high rates of STIs experienced by African American females (Adimora & Schoenbach, 2002, 2005; Akers, Muhammad, & Corbie-Smith, 2011; Andrinopoulos et al, 2006; Doherty et al, 2007; Doherty et al, 2009; Farley, 2006; Jennings & Ellen, 2004; Johnson & Rapheal, 2009; Latkin, Curry, Hua, & Davey, 2007; Laumann & Youm, 1999; Sullivan et al, 2011; Zierler, & Krieger, 1997). Among the sexual partner characteristics linked to STI status are male partner’s history of incarceration, substance use/abuse, and sexual concurrency (Adimora, Schoenbach, & Doherty, 2006; Johnson & Rapheal, 2009).…”

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