Social context, sexual networks, and racial disparities in rates of sexually transmitted infections

Background. Social context ( demographic, socioeconomic, macroeconomic, and sociopolitical features of the environment) influences the epidemiology and consequences of individual behaviors that affect health outcomes. This article examines the role of social context in heterosexual networks that facilitate the spread of human immunodeficiency virus (HIV) infection and other sexually transmitted infections (STIs), particularly in relation to persistent racial disparities in rates of STIs in the United States. Methods. Review of the medical, public health, and social science literature. Results. Contextual factors, such as poverty, discrimination, epidemiology of illicit drug use in the community, ratio of men to women, incarceration rates, and racial segregation, influence sexual behavior and sexual networks directly and indirectly through a variety of mechanisms. Disparities in these contextual features likely contribute substantially to the persistence of marked racial disparities in rates of STIs. Conclusions. Given the importance of contextual factors and the sharply contrasting social contexts for blacks and whites, exclusive emphasis on individual risk factors and determinants is unlikely to produce solutions that will significantly decrease HIV rates among blacks. Effective HIV prevention in this population will require multidisciplinary research to address the contextual factors that promote patterns of sexual networks that facilitate transmission of STIs.