Community Gender Balance and HIV/STI Risk in a Multi-Racial-Ethnic Population Sample

Background: Racial-ethnic disparities in the risk of heterosexual transmission of HIV and other sexually transmitted infections (STI) have been hypothesized to be related to the high rate of incarceration and the shortage of men in Black communities. These hypotheses have not been explored using national population-based data.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 were matched with 2000 Census data on the male-female sex ratio, and the population rate of men in correctional facilities for non-Hispanic Black, non-Hispanic white and Hispanic participants. Logistic regressions, stratified by gender and race-ethnicity, were used to examine whether these factors accounted for differences in sexual partnerships in the past year.

Results: Because non-Hispanic Black sex ratios were much lower than sex ratios of other racial-ethnic groups the comparability of results was limited; however, several significant associations were observed within each group. In multivariable analyses, non-Hispanic Black men who resided in counties with greater male shortage, and higher male correctional facility rates among non-Hispanic Blacks were more likely to have reported having had multiple partners, and having had 5 or more partners in the past year. Results were similar in analyses that adjusted for Census estimates of undercounting.

Conclusions: Gender balance may help to shape sexual behavior, and disparities in gender balance may underlie disparities in HIV/STI incidence. The high rate of incarceration, and the shortage of men in Black communities may constitute under-recognized public health problems.