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The Geography of Heterosexual Partnerships in Baltimore City Adults

Gindi, Renee M. PHD*; Sifakis, Frangiscos PHD; Sherman, Susan G. PHD; Towe, Vivian L. PHD; Flynn, Colin ScM; Zenilman, Jonathan M. MD§

Sexually Transmitted Diseases: April 2011 - Volume 38 - Issue 4 - p 260-266
doi: 10.1097/OLQ.0b013e3181f7d7f4
Original Study

Background: Human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk is determined in part by sexual network characteristics, which include spatial parameters. Geography and proximity of partner selection are important factors, which may explain neighborhood-level differences in HIV/STD morbidity. To study the effects of neighborhood factors on HIV/STD transmission in high-density urban areas, the geography of partner selection must be understood.

Methods: The Baltimore site of the National HIV Behavioral Surveillance system surveyed adults reporting one or more heterosexual partnerships. Spatial assortativity was defined as both partners residing in the same or adjacent census tracts and based on participant report. HIV core areas were defined as the census tracts in the top quartile for standardized HIV/AIDS case rates.

Results: Participants (n = 307) provided data on 776 recent sexual partnerships, and geographic information were obtained for 510 partnerships (66%). Almost half (47%) reported choosing spatially assortative partners. Participants who lived in high HIV-prevalence areas were more likely to choose spatially assortative partners than residents of lower prevalence areas after adjusting for partnership type, gender, and number of partners. Although this population exhibited assortative mixing in all types of partnerships, racial and age assortativities were not associated with choosing spatially assortative partners.

Conclusions: Over 15 years ago, STD clinic patients in Baltimore were found to seek partners within close proximity. We confirm these results in a non-STD clinic population, indicating a continuing need for neighborhood approaches to intervention programs in urban areas.

A survey in a high-density urban area finds that spatial assortativity in heterosexual partnerships is common, especially among those living in high human immunodeficiency virus prevalence areas and exchange (sex for drugs/money) partnerships.

From the *National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD; †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Maryland Department of Health and Mental Hygiene, Office of AIDS Administration, Baltimore, MD; and §Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD

Tim Shields assisted with generating adjacent census tracts. The authors thanks to the BESURE study staff and participants.

Supported by the National Institutes of Mental Health (F31 MH080625–01) (to R.G.). The parent study was supported by the Centers for Disease Control and Prevention (grant PS-964–01).

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention or the National Center for Health Statistics.

Correspondence: Renee M. Gindi, PhD, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 2118, MS P08, Hyattsville, MD 20782. E-mail:

Received for publication April 26, 2010, and accepted August 16, 2010.

© Copyright 2011 American Sexually Transmitted Diseases Association