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Concurrent sexual partnerships i. Social capital, defined as resources and connections available to individuals is hypothesized to reduce sexual HIV risk behavior, including sexual concurrency. Additionally, we do not know whether any association between social capital and sexual concurrency is moderated by gender.
Multivariable logistic regression tested the association between social capital and sexual concurrency and effect modification by gender. Interventions that add social capital components may be important for lowering sexual risk among African Americans in Mississippi.
Sespecially in the south [ 1 ]. Disparities by race and gender are pronounced. Within Jackson, MS, inthe rate of infection perwas 62 for African American men compared to 7 for white men, 15 for African American women, and 2 for white women [ 4 ].
Racial and ethnic disparities in HIV are not wholly explained by differences in sexual or drug use risk behaviors but rather, attributed to other factors such as delays in testing and accessing HIV prevention, differences in sociodemographic factors of sexual partners e. In some American cities with a high proportion of African Americans, structural factors, including incarceration and poor economic prospects increase the flow of people that leave while also creating imbalances in male to female sex ratios among those who remain [ 1112 ].
Jackson, MS is the 3rd highest racially segregated city in the U. S [ 13 ], and the overall population of MS has been declining, primarily due to domestic outmigration [ 14 ]. studies have identified high rates of concurrent sexual partnerships in Mississippi [ 1516 ]. Therefore, understanding risk factors for concurrent sexual partnerships may inform interventions that reduce self-reported HIV risk behaviors.
Social capital is a multidimensional construct that is operationalized typically within two broad approaches: cognitive and structural [ 17 ]. The cognitive approach, also sometimes referred to as social cohesion, emphasizes perceptions of trust, sharing, and reciprocity.
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In contrast, the structural approach emphasizes social networks, civic engagement, participation in organiztions, social control, and other group-level properties. There is some debate whether social cohesion is an antecedent to social capital [ 20 ].
Others find utility in seeing both as one broad construct [ 18 ], encompassing multiple forms, and connected to social embeddedness [ 21 ]. Thus, we define social capital broadly as collective resources available to individuals based on social connections [ 1819 ].
In this study, perceived neighborhood social capital was operationalized at the individual level. This means that individuals reported their perceptions, but the data were not aggregated to the neighborhood level because geographic identifiers were not available. Social capital has been put forth in many theoretical models as a determinant that influences self-reported HIV risk and transmission [ 2223 ].
Some mechanisms are related to the acquisition of social capital at the individual level as well as facilitating links to health behaviors. Some mechanisms hypothesized to link social capital at the individual level to health behaviors include diffusion of information and psychosocial processes that improve coping, self-esteem, and respect. Those mechanisms either have direct effects or buffer the effects of other determinants such as poverty, depression, and excessive alcohol use [ 18272829 ].
Behavioral and psychological factors such as excessive alcohol use, depression, and self-reported HIV risk may also vary by gender and thus are important to examine as main variables rather than confounders. African American women, compared to men, have lower rates of drinking and alcohol abuse [ 30 ]. While depressive symptoms may be manifested and thus diagnosed differently among African Americans [ 31 ], the diagnosed prevalence is higher among women compared to men [ 32 ].
Finally, although self-reported HIV risk is complex in that it depends on relationship status and other contextual factors such as HIV prevalence [ 33 ], African American women compared to men identify more frequently with lower self-reported HIV risk [ 3435 ].
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There is compelling evidence that social capital is associated with HIV-related risk and protective factors such as condom use, of sexual partners, and HIV testing [ 26 ]. It is unclear, however, whether social capital is associated with sexual concurrency, which is the first question we investigate in this study. Broadly, mechanisms hypothesized to link social capital to lower self-reported HIV risk include higher access to material resources, which can leverage negotiating safer sexual practices such as using condoms and reducing the of overlapping sexual partners [ 3637 ].
Based on theory and empirical evidence, it is plausible that gender may modify the relationship between social capital at the individual level and self-reported HIV risk behaviors, such as sexual concurrency, which is the second question we investigate in this study. The theory of gender and power posits that there are gendered relationships between men and women [ 39 ] that could influence risk. The division of labor can produce gender differences in self-reported HIV risk, particularly in the south, because women are posited to more heavily rely on their social networks for support [ 40 ].
Women compared to men also tend to have higher levels of family responsibilities e. Also, individual and societal perceptions and expectations of sexual roles, structural conditions such as incarceration differentially affect social capital levels between African American men and women.
High incarceration rates of African American men in the U. These conditions create higher likelihoods that African American women end up or stay in non-monogamous and overlapping sexual relationships with their male partners [ 40 ]. Other work has shown that prior incarceration is associated with an increased rate of lifetime sexual partnerships for men [ 47 ]. There is compelling empirical evidence of gender differences in the association between social capital and HIV diagnosis and sexual risk behavior [ 48 ].
However, the evidence is mixed about the directions of associations and no studies have examined sexual concurrency. One study in Eastern Zimbabwe showed that social capital was associated with lower HIV incidence, yet the magnitude of the association was larger for women compared to men. Women were able to leverage their social capital to adopt safer sexual practices [ 49 ]. One study among adults in South Africa found that cognitive social capital e. That study did not provide sufficient explanations for the gendered patterns of those associations.
Understanding the role of social capital in having concurrent sexual partnerships hereafter, sexual concurrencyas one HIV acquisition risk factor, may be necessary to reduce racial disparities, especially among women, in the Mississippi and across the south. In the present study, we examined the association between social capital and sexual concurrency and then tested whether gender modified that association. As a second objective, we tested the hypothesis that psychosocial and behavioral factors: excessive alcohol use, depressive symptoms, and self-reported HIV risk attenuate any gender differences found.
Data were drawn from a cross-sectional study of individuals who presented for care at a publicly funded STI clinic in Jackson, Mississippi. Recruitment and data collection procedures have been ly described Nunn et al. Individuals were eligible to participate if they met the following criteria: 1 at least 18 years of age, 2 presenting for STI and HIV screening, 3 willing to complete a 30 min computerized behavioral survey, and 4 spoke English.
Participants did not receive compensation for their participation, and all provided informed consent before completing the self-administered computerized survey. The computerized survey solicited information regarding sociodemographic characteristics, substance use, sexual behavior history, access to medical care, as well as structural factors.
A social cohesion-based approach [ 18 ] was used to operationalize perceived neighborhood social capital, which was assessed using a validated scale [ 52 ]. Consistent with prior work [ 52 ], a z-scored summary index variable with mean of 0 and SD of 1 was created, rather than analyze individual items.
Although the questions ask about their neighborhood and neighbors, the data are all at the individual level. In our analyses, we included the following socioeconomic variables: age, gender men vs. We first examined the distributional properties of each variable. To assess the relationship between social capital and sexual concurrency in our analytic sample, we used multivariable logistic regression, adjusting for age, gender, sexual orientation, marital status, education, income, employment, and public assistance Model 1.
We tested for differences on the multiplicative scale between men and women using the Adjusted Wald Test and confirmed the by performing interaction contrasts of gender differences on the probability scale marginsand on the additive scale since interactions may be present on one scale but not another [ 5556 ]. Social capital was coded into a binary variable to calculate the RERI since values have to be chosen even from continuously scored variables. To accomplish our secondary objective, whether psychosocial and behavioral factors can attenuate gender differences in social capital and concurrency, an additional model was created Model 2 in which we subsequently adjusted for excessive alcohol use, self-reported depression, and self-reported HIV risk.
To improve specification of the model, we entered an interaction term between AUDIT-C hazardous alcohol use and self-reported HIV risk because prior work showed strong causal associations in the context of sexual risk [ 58 ].
We reported two-sided p- values. When ificant interactions were found, we plot the using the margins command based on the adjusted Model 2. Table 1 shows the sociodemographic characteristics of the analytic sample. The average age was A total of participants The average social capital score for the whole analytic sample was 2. Table 2 shows the multivariable logistic regression models for sexual concurrency in the current year.
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In initial main effect models, gender but not social capital was ificant result not displayed. The graphical illustration in Fig. Table 3 contains of analyses from sexual concurrency in the past year. The pattern of and the interaction plot not presented were very similar to those in the current year and so are not presented. The effect modification coefficients were presented on the multiplicative scale for men and women.
This suggests that if social capital was a scarce resource, then social capital interventions for sexual concurrency might have a greater public health benefit if targeted towards men, and this interpretation was based on us coding men 0 and women 1 in the statistical models. The graphical association showing that the risk of having a concurrent sexual partner in the past year is higher for men compared to women as social capital levels increase. Sexual concurrency remains a key risk factor that contributes to high HIV incidence among African Americans, particularly in the south, and more likely to have an adverse impact on women.
Social capital has been associated with other self-reported HIV risk behaviors such condom use. However, no prior studies examined its association with sexual concurrency. Therefore, we examined whether social capital was associated with sexual concurrency, and whether gender moderated any association found.