Exploring mechanisms potentially underlying racial/ethnic disparities in human immunodeficiency virus and other sexually transmitted infections using population-based data

The purpose of this dissertation was to investigate social and behavioral mechanisms that may underlie racial/ethnic disparities in incidence and prevalence of human immunodeficiency virus (HIV), and other sexually transmitted infections (STI) using a national population-based sample. The study population was the 31,999 participants from the 1999-2004 data collection waves of the National Health and Nutrition Examination Survey (NHANES). Population data were obtained from the 2000 US Census, and matched with the individual data from NHANES by the county of residence of the participant.;Three independent manuscripts focusing on mechanisms that potentially underlie racial/ethnic HIV/STI disparities were developed for this dissertation. The first examined the probability of being diagnosed with genital herpes, among participants who were infected with the virus that causes genital herpes. Non-Hispanic Blacks, and participants without current health insurance were less likely to be diagnosed. The second manuscript tested the hypothesis that low male-female sex ratios, and high incarceration rates predict increased numbers of sexual partners. It found that non-Hispanic Black men were more likely to have had more partners in the past year if they resided in a county with male shortage or high incarceration. It is unclear whether racial/ethnic differences in these associations were due to differences in exposure levels, or other factors. The third manuscript examined racial/ethnic differences in consistent condom use among participants who had 2 or more recent sexual partners. Having more lifetime sexual partners was associated with less consistent condom use. The results suggest that prior condom use promotion messages may not have reached those at greatest risk for HIV/STI infection. Racial/ethnic differences in HIV/STI prevalence in NHANES were not echoed in reported consistent condom use.;If these results are replicated, and causal relationships can be established through other research designs, then racial/ethnic HIV/STI disparities could potentially be reduced by programs that increase sexual and reproductive healthcare utilization, or lead to greater gender balance among Blacks. Such changes could also provide other social and public health benefits, including improved reproductive and neonatal health, and more stable heterosexual relationships.