Travel time to health care provider is associated with testing positive for Gonorrhea, Chlamydia, or Trichomonas in a sample of public housing residents

Background: High STI rates have been explained by sexual behavior, sexual networks, and rates of incarceration among other factors, and are greater in areas of high poverty and drug use. In addition, spatial access to healthcare may affect how rapidly STIs are treated and likelihood of spread. The current analysis evaluates the relationship between travel time to health care provider and likelihood of testing positive for one of three STIs in a sample of public housing residents from 5 neighborhoods. Methods: One hundred and three subjects recruited to participate in a study of housing relocation and HIV risk completed a computer assisted personal interview. STI-positives had urine PCR positive for N. gonorrhea, C. trachomatis, or T. vaginalis. Travel time was a continuous variable of number of minutes it took to reach the place where they got most of their care. Analyses used generalized estimating equations to address neighborhood clustering. The multivariate model controlled for sociodemographic characteristics, STI history, and sexual behavior. Travel time was squared to linearize relationship. Results: Thirty six residents tested positive for one or more STI. A non-linear relationship existed between travel time and STI status. When travel time was <43 minutes, a positive relationship existed between travel time and the odds of testing positive for an STI, though the magnitude of this relationship declined as travel time rose. An inverse relationship existed when travel time was >43 minutes. Conclusion: Residents of impoverished communities experience improved sexual health if healthcare services require less travel time to reach.