Archives of Sexual Behavior

, Volume 47, Issue 5, pp 1451–1463 | Cite as

Associations Between Neighborhood Characteristics, Social Cohesion, and Perceived Sex Partner Risk and Non-Monogamy Among HIV-Seropositive and HIV-Seronegative Women in the Southern U.S.

  • Danielle F. HaleyEmail author
  • Gina M. Wingood
  • Michael R. Kramer
  • Regine Haardörfer
  • Adaora A. Adimora
  • Anna Rubtsova
  • Andrew Edmonds
  • Neela D. Goswami
  • Christina Ludema
  • DeMarc A. Hickson
  • Catalina Ramirez
  • Zev Ross
  • Hector Bolivar
  • Hannah L. F. Cooper
Original Paper


Neighborhood social and physical factors shape sexual network characteristics in HIV-seronegative adults in the U.S. This multilevel analysis evaluated whether these relationships also exist in a predominantly HIV-seropositive cohort of women. This cross-sectional multilevel analysis included data from 734 women enrolled in the Women’s Interagency HIV Study’s sites in the U.S. South. Census tract-level contextual data captured socioeconomic disadvantage (e.g., tract poverty), number of alcohol outlets, and number of non-profits in the census tracts where women lived; participant-level data, including perceived neighborhood cohesion, were gathered via survey. We used hierarchical generalized linear models to evaluate relationships between tract characteristics and two outcomes: perceived main sex partner risk level (e.g., partner substance use) and perceived main sex partner non-monogamy. We tested whether these relationships varied by women’s HIV status. Greater tract-level socioeconomic disadvantage was associated with greater sex partner risk (OR 1.29, 95% CI 1.06–1.58) among HIV-seropositive women and less partner non-monogamy among HIV-seronegative women (OR 0.69, 95% CI 0.51–0.92). Perceived neighborhood trust and cohesion was associated with lower partner risk (OR 0.83, 95% CI 0.69–1.00) for HIV-seropositive and HIV-seronegative women. The tract-level number of alcohol outlets and non-profits were not associated with partner risk characteristics. Neighborhood characteristics are associated with perceived sex partner risk and non-monogamy among women in the South; these relationships vary by HIV status. Future studies should examine causal relationships and explore the pathways through which neighborhoods influence partner selection and risk characteristics.


HIV Neighborhood characteristics Sexual risk Multilevel analyses Social cohesion 



The authors thank the Women’s Interagency HIV Study participants for sharing their time and experiences. The authors also acknowledge the efforts and dedication of WIHS study staff, with special thanks to Ighovwerha Ofotokun, Sarah Sanford, Deja Er, Rachael Farah-Abraham, Carrigan Parrish, Zenoria Causey, Venetra McKinney, Erin Balvanz, and Lisa Rohn. In addition, the authors express sincere thanks to the regulatory and law enforcement agencies that provided data needed to construct census tract predictors.


This work was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number F31MH105238, the Surgeon General C. Everett Koop HIV/AIDS Research Grant, the George W. Woodruff Fellowship of the Laney Graduate School, the Emory Center for AIDS Research (P30 AI050409), the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number K01HD074726, and the Centers for Disease Control and Prevention under Cooperative Agreement U01PS003315 as part of the Minority HIV/AIDS Research Initiative. Participant data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS): UAB-MS WIHS (PIs: Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (PIs: 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. The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases, with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Mental Health. 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). 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. The NC Department of Health and Human Services does not take responsibility for the scientific validity or accuracy of methodology, results, statistical analyses, or conclusions presented.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study. This secondary analysis is restricted to individual participants who provided written informed consent to collect and geocode their home address.


  1. Adimora, A. A., Hughes, J. P., Wang, J., Haley, D. F., Golin, C. E., Magnus, M., & Hodder, S. L. (2013a). Characteristics of multiple and concurrent partnerships among women at high risk for HIV infection. Journal of Acquired Immune Deficiency Syndrome, 65(1), 99–106. Scholar
  2. Adimora, A. A., Ramirez, C., Schoenbach, V. J., & Cohen, M. S. (2014). Policies and politics that promote HIV infection in the Southern United States. AIDS, 28(10), 1393–1397. Scholar
  3. Adimora, A., Schoenbach, V., Martinson, F., Coyne-Beasley, T., Doherty, I., Stancil, T. R., & Fullilove, R. E. (2006a). Risk factors for heterosexually transmitted HIV infection among African Americans in North Carolina. Journal of Acquired Immune Deficiency Syndrome, 41, 616–623.CrossRefGoogle Scholar
  4. Adimora, A. A., Schoenbach, V. J., Martinson, F. E., Coyne-Beasley, T., Doherty, I., Stancil, T. R., & Fullilove, R. E. (2006b). Heterosexually transmitted HIV infection among African Americans in North Carolina. Journal of Acquired Immune Deficiency Syndrome, 41(5), 616–623. Scholar
  5. Adimora, A. A., Schoenbach, V. J., Martinson, F. E., Donaldson, K. H., Fullilove, R. E., & Aral, S. O. (2001). Social context of sexual relationships among rural African Americans. Sexually Transmitted Diseases, 28(2), 69–76.CrossRefPubMedGoogle Scholar
  6. Adimora, A. A., Schoenbach, V. J., Taylor, E. M., Khan, M. R., Schwartz, R. J., & Miller, W. C. (2013b). Sex ratio, poverty, and concurrent partnerships among men and women in the United States: A multilevel analysis. Annals of Epidemiology, 23(11), 716–719. Scholar
  7. Bacon, M. C., von Wyl, V., Alden, C., Sharp, G., Robison, E., Hessol, N., & Young, M. A. (2005). The Women’s Interagency HIV Study: An observational cohort brings clinical sciences to the bench. Clinical and Diagnostic Laboratory Immunology, 12(9), 1013–1019. Scholar
  8. Barkan, S. E., Melnick, S. L., Preston-Martin, S., Weber, K., Kalish, L. A., Miotti, P., & Feldman, J. (1998). The Women’s Interagency HIV Study. WIHS Collaborative Study Group. Epidemiology, 9(2), 117–125.CrossRefPubMedGoogle Scholar
  9. Bauer, D. J., & Sterba, S. K. (2011). Fitting multilevel models with ordinal outcomes: Performance of alternative specifications and methods of estimation. Psychological Methods, 16(4), 373–390. Scholar
  10. Bauermeister, J. A., Zimmerman, M. A., & Caldwell, C. H. (2011). Neighborhood disadvantage and changes in condom use among African American adolescents. Journal of Urban Health, 88(1), 66–83. Scholar
  11. Bell, B. A., Morgan, G. B., Kromrey, J. D., & Ferron, J. M. (2010). The impact of small cluster size on multilevel models: A Monte Carlo examination of two-level models with binary and continuous predictors. Paper presented at the Joint Statistical Meetings, Vancouver, BC.Google Scholar
  12. Bohn, M. J., Babor, T. F., & Kranzler, H. R. (1995). The Alcohol Use Disorders Identification Test (AUDIT): Validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol and Drugs, 56, 423–432.CrossRefGoogle Scholar
  13. Brandt, P. A., & Weinert, C. (1981). The PRQ-A social support measure. Nursing Research, 30, 227–230.CrossRefGoogle Scholar
  14. Campbell, C. A., Hahn, R. A., Elder, R., Brewer, R., Chattopadhyay, S., Fielding, J., & Middleton, J. C. (2009). The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. American Journal of Preventive Medicine, 37(6), 556–569. Scholar
  15. Centers for Disease Control and Prevention. (2015). HIV surveillance report, 2014 (Vol. 26). Accessed 3 April 2017.
  16. Chesson, H. W., Owusu-Edusei, K., Leichliter, J. S., & Aral, S. O. (2013). Violent crime rates as a proxy for the social determinants of sexually transmissible infection rates: the consistent state-level correlation between violent crime and reported sexually transmissible infections in the United States, 1981–2010. Sexual Health, 10(5), 419–423. Scholar
  17. Cohen, D. A., Ghosh-Dastidar, B., Scribner, R., Miu, A., Scott, M., Robinson, P., & Brown-Taylor, D. (2006). Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: A longitudinal analysis. Social Science and Medicine, 62(12), 3062–3071. Scholar
  18. Cohen, D., Spear, S., Scribner, R., Kissinger, P., Mason, K., & Wildgen, J. (2000). “Broken windows” and the risk of gonorrhea. American Journal of Public Health, 90(2), 230–236.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Cooper, H. L., Bonney, L., Luo, R., Haley, D. F., Linton, S., Hunter-Jones, J., & Rothenberg, R. (2016). Public housing relocations and partnership dynamics in areas with high prevalences of sexually transmitted infections. Sexually Transmitted Diseases, 43(4), 222–230. Scholar
  20. Cooper, H. L., Bonney, L. E., Ross, Z., Karnes, C., Hunter-Jones, J., Kelley, M. E., & Rothenberg, R. (2013). The aftermath of public housing relocation: Relationship to substance misuse. Drug and Alcohol Dependence, 133(1), 37–44. Scholar
  21. Cooper, H. L., Haley, D. F., Linton, S., Hunter-Jones, J., Martin, M., Kelley, M. E., & Bonney, L. E. (2014). Impact of public housing relocations: Are changes in neighborhood conditions related to STIs among relocaters? Sexually Transmitted Diseases, 41(10), 573–579. Scholar
  22. Cooper, H. L., Linton, S., Haley, D. F., Kelley, M. E., Dauria, E. F., Karnes, C. C., & Bonney, L. E. (2015). Changes in exposure to neighborhood characteristics are associated with sexual network characteristics in a cohort of adults relocating from public housing. AIDS and Behavior, 19(6), 1016–1030. Scholar
  23. Crosby, R. A., Holtgrave, D. R., DiClemente, R. J., Wingood, G. M., & Gayle, J. A. (2003). Social capital as a predictor of adolescents’ sexual risk behavior: A state-level exploratory study. AIDS and Behavior, 7(3), 245–252.CrossRefPubMedGoogle Scholar
  24. Dauria, E. F., Oakley, L., Arriola, K. J., Elifson, K., Wingood, G., & Cooper, H. L. (2015). Collateral consequences: Implications of male incarceration rates, imbalanced sex ratios and partner availability for heterosexual Black women. Culture, Health & Sexuality, 17(10), 1190–1206. Scholar
  25. Doherty, I. A., Serre, M. L., Gesink, D., Adimora, A. A., Muth, S. Q., Leone, P. A., & Miller, W. C. (2012). Sexual networks, surveillance, and geographical space during syphilis outbreaks in rural North Carolina. Epidemiology, 23(6), 845–851. Scholar
  26. Ford, J. L., & Browning, C. R. (2013). Neighborhoods and infectious disease risk: Acquisition of chlamydia during the transition to young adulthood. Journal of Urban Health, 91(1), 136–150. Scholar
  27. Gindi, R. M., Sifakis, F., Sherman, S. G., Towe, V. L., Flynn, C., & Zenilman, J. M. (2011). The geography of heterosexual partnerships in Baltimore city adults. Sexually Transmitted Diseases, 38(4), 260–266. Scholar
  28. Green, T. C., Pouget, E. R., Harrington, M., Taxman, F. S., Rhodes, A. G., O’Connell, D., … Friedmann, P. D. (2012). Limiting options: Sex ratios, incarceration rates, and sexual risk behavior among people on probation and parole. Sexually Transmitted Diseases, 39(6), 424–430. Scholar
  29. Hessol, N. A., Anastos, K., Levine, A. M., Ameli, N., Cohen, M., Young, M., & Gange, S. J. (2000). Factors associated with incident self-reported AIDS among women enrolled in the Women’s Interagency HIV Study (WIHS). AIDS Research and Human Retroviruses, 16(12), 1105–1111. Scholar
  30. Hessol, N. A., Schneider, M., Greenblatt, R. M., Bacon, M., Barranday, Y., Holman, S., & Weber, K. (2001). Retention of women enrolled in a prospective study of human immunodeficiency virus infection: Impact of race, unstable housing, and use of human immunodeficiency virus therapy. American Journal of Epidemiology, 154(6), 563–573.CrossRefPubMedGoogle Scholar
  31. Hessol, N. A., Weber, K. M., Holman, S., Robison, E., Goparaju, L., Alden, C. B., & Ameli, N. (2009). Retention and attendance of women enrolled in a large prospective study of HIV-1 in the United States. Journal of Womens Health, 18(10), 1627–1637. Scholar
  32. Hixson, B. A., Omer, S. B., del Rio, C., & Frew, P. M. (2011). Spatial clustering of HIV prevalence in Atlanta, Georgia and population characteristics associated with case concentrations. Journal of Urban Health, 88(1), 129–141. Scholar
  33. Holtgrave, D. R., & Crosby, R. A. (2003). Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States. Sexually Transmitted Infections, 79(1), 62–64.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Jennings, J., Glass, B., Parham, P., Adler, N., & Ellen, J. M. (2004). Sex partner concurrency, geographic context, and adolescent sexually transmitted infections. Sexually Transmitted Diseases, 31(12), 734–739.CrossRefPubMedGoogle Scholar
  35. Jennings, J. M., Taylor, R., Iannacchione, V. G., Rogers, S. M., Chung, S. E., Huettner, S., & Ellen, J. M. (2010). The available pool of sex partners and risk for a current bacterial sexually transmitted infection. Annals of Epidemiology, 20(7), 532–538. Scholar
  36. Jennings, J. M., Woods, S. E., & Curriero, F. C. (2013). The spatial and temporal association of neighborhood drug markets and rates of sexually transmitted infections in an urban setting. Health & Place, 23, 128–137. Scholar
  37. Justman, J., Befus, M., Hughes, J., Wang, J., Golin, C. E., Adimora, A. A., & Hodder, S. (2015). Sexual behaviors of US women at risk of HIV acquisition: A longitudinal analysis of findings from HPTN 064. AIDS and Behavior, 19(7), 1327–1337. Scholar
  38. Kerrigan, D., Witt, S., Glass, B., Chung, S. E., & Ellen, J. (2006). Perceived neighborhood social cohesion and condom use among adolescents vulnerable to HIV/STI. AIDS and Behavior, 10(6), 723–729. Scholar
  39. Lang, D. L., Sales, J. M., Salazar, L. F., DiClemente, R. J., Crosby, R. A., Brown, L. K., & Donenberg, G. R. (2011). Determinants of multimethod contraceptive use in a sample of adolescent women diagnosed with psychological disorders. Infectious Diseases in Obstetrics and Gynecology, 2011, 510239. Scholar
  40. Lewis, V. A., Macgregor, C. A., & Putnam, R. D. (2013). Religion, networks, and neighborliness: The impact of religious social networks on civic engagement. Social Science Research, 42(2), 331–346. Scholar
  41. Linton, S. L., Cooper, H. L., Luo, R., Karnes, C., Renneker, K., Haley, D. F., & Rothenberg, R. (2017a). Changing places and partners: Associations of neighborhood conditions with sexual network turnover among African American adults relocated from public housing. Archives of Sexual Behavior, 46(4), 925–936. Scholar
  42. Linton, S. L., Haley, D. F., Hunter-Jones, J., Ross, Z., & Cooper, H. L. F. (2017b). Social causation and neighborhood selection underlie associations of neighborhood factors with illicit drug-using social networks and illicit drug use among adults relocated from public housing. Social Science and Medicine, 185, 81–90. Scholar
  43. Liu, C., Hu, H., Goparaju, L., Plankey, M., Bacchetti, P., Weber, K., & Wilson, T. E. (2011). Sexual serosorting among women with or at risk of HIV infection. AIDS and Behavior, 15(1), 9–15. Scholar
  44. Marks, G., Crepaz, N., Senterfitt, J. W., & Janssen, R. S. (2005). Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs. Journal of Acquired Immune Deficency Syndrome, 39(4), 446–453.CrossRefGoogle Scholar
  45. National Center for Charitable Statistics. (2014). IRS business master files. Retrieved April 3, 2017 from
  46. Pouget, E. R., Kershaw, T. S., Niccolai, L. M., Ickovics, J. R., & Blankenship, K. M. (2010). Associations of sex ratios and male incarceration rates with multiple opposite-sex partners: Potential social determinants of HIV/STI transmission. Public Health Reports, 125(Suppl. 4), 70–80.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. New York: Simon & Schuster.CrossRefGoogle Scholar
  48. Reif, S., Pence, B. W., Hall, I., Hu, X., Whetten, K., & Wilson, E. (2015). HIV diagnoses, prevalence and outcomes in nine southern states. Journal of Community Health, 40(4), 642–651. Scholar
  49. Reif, S. S., Whetten, K., Wilson, E. R., McAllaster, C., Pence, B. W., Legrand, S., & Gong, W. (2014). HIV/AIDS in the Southern USA: A disproportionate epidemic. AIDS Care, 26(3), 351–359. Scholar
  50. Rudolph, A. E., Linton, S., Dyer, T. P., & Latkin, C. (2013). Individual, network, and neighborhood correlates of exchange sex among female non-injection drug users in Baltimore, MD (2005–2007). AIDS and Behavior, 17(2), 598–611. Scholar
  51. Sampson, R. J., Raudenbush, S. W., & Earls, F. (1997). Neighborhoods and violent crime: A multilevel study of collective efficacy. Science, 277(5328), 918–924.CrossRefPubMedGoogle Scholar
  52. Seth, P., Wingood, G. M., & DiClemente, R. J. (2008). Exposure to alcohol problems and its association with sexual behaviour and biologically confirmed Trichomonas vaginalis among women living with HIV. Sexually Transmitted Infections, 84(5), 390–392. Scholar
  53. Song, R., Hall, H. I., Harrison, K. M., Sharpe, T. T., Lin, L. S., & Dean, H. D. (2011). Identifying the impact of social determinants of health on disease rates using correlation analysis of area-based summary information. Public Health Reports, 126(Suppl. 3), 70–80.CrossRefPubMedPubMedCentralGoogle Scholar
  54. Spiegelman, D., & Hertzmark, E. (2005). Easy SAS calculations for risk or prevalence ratios and differences. American Journal of Epidemiology, 162(3), 199–200. Scholar
  55. Tempalski, B., Flom, P. L., Friedman, S. R., Des Jarlais, D. C., Friedman, J. J., McKnight, C., & Friedman, R. (2007). Social and political factors predicting the presence of syringe exchange programs in 96 US metropolitan areas. American Journal of Public Health, 97(3), 437–447. Scholar
  56. Theall, K. P., Lancaster, B. P., Lynch, S., Haines, R. T., Scribner, S., Scribner, R., & Kishore, V. (2011). The neighborhood alcohol environment and at-risk drinking among African-Americans. Alcoholism, Clinical and Experimental Research, 35(5), 996–1003. Scholar
  57. Theall, K. P., Scribner, R., Ghosh-Dastidar, B., Cohen, D., Mason, K., & Simonsen, N. (2009). Neighbourhood alcohol availability and gonorrhea rates: Impact of social capital. Geospatial Health, 3(2), 241–255.CrossRefPubMedGoogle Scholar
  58. Thomas, J. C., Torrone, E. A., & Browning, C. R. (2010). Neighborhood factors affecting rates of sexually transmitted diseases in Chicago. Journal of Urban Health, 87(1), 102–112. Scholar
  59. US Department of Housing and Urban Development. (2015). HUD aggregated USPS administrative data on address vacancies. Retrieved April 3, 2017 from
  60. VanderWeele, T. J. (2015). Explanation in causal inference: Methods for mediation and interaction. New York: Oxford University Press.Google Scholar
  61. Wingood, G. M., Camp, C., Dunkle, K., Cooper, H., & DiClemente, R. J. (2010). HIV prevention and heterosexual African American women. In D. H. McCree, K. T. Jones, & A. O’Leary (Eds.), African Americans and HIV/AIDS: Understanding and addressing the epidemic (pp. 211–221). New York: Springer.CrossRefGoogle Scholar
  62. Wingood, G. M., & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education and Behavior, 27(5), 539–565.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Danielle F. Haley
    • 1
    • 2
    Email author
  • Gina M. Wingood
    • 3
  • Michael R. Kramer
    • 4
  • Regine Haardörfer
    • 2
  • Adaora A. Adimora
    • 1
    • 5
  • Anna Rubtsova
    • 2
  • Andrew Edmonds
    • 5
  • Neela D. Goswami
    • 4
    • 6
  • Christina Ludema
    • 1
  • DeMarc A. Hickson
    • 7
  • Catalina Ramirez
    • 1
  • Zev Ross
    • 8
  • Hector Bolivar
    • 9
  • Hannah L. F. Cooper
    • 2
  1. 1.Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel Hill School of MedicineChapel HillUSA
  2. 2.Department of Behavioral Sciences and Health EducationRollins School of Public Health at Emory UniversityAtlantaUSA
  3. 3.Department of Sociomedical Sciences, Lerner Center for Public Health PromotionMailman School of Public Health at Columbia UniversityNew YorkUSA
  4. 4.Department of EpidemiologyRollins School of Public Health at Emory UniversityAtlantaUSA
  5. 5.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  6. 6.Division of Infectious DiseasesEmory University School of MedicineAtlantaUSA
  7. 7.Department of Epidemiology and BiostatisticsJackson State University School of Public HealthJacksonUSA
  8. 8.ZevRoss Spatial AnalysisIthacaUSA
  9. 9.Division of Infectious DiseasesUniversity of Miami Miller School of MedicineMiamiUSA

Personalised recommendations