Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: A network explanation

Background: Many studies have observed that African Americans have comparat ively high rates of selected STDs, often 10 to 20 times higher than whites and other racial/ethnic groups, but without convincing explanation, Goal: This study attempts to solve this puzzle using data from a nationally representative probability sample and a network approach, Study design: The National Health and Social Life Survey (NHSLS) is a natio nally representative probability sample of 1,511 men and 1,921 women in the United States. Logistic regression analysis of these data permit a multiva riate analysis of the individual risk factors associated with STDs, Using l oglinear analysis and a simulation, we also identify the effects of sexual network patterns within and between racial/ethnic groups. Results: Logistic regression analysis of the NHSLS re revealed, even after controlling for all the appropriate individual-level risk factors, that Afr ican Americans are almost five times more likely to be infected by bacteria l diseases than the other racial/ ethnic groups. Conclusions: African Americans' higher infection rate for bacterial disease s can be explained by the patterns of sexual networks within and between di fferent racial/ethnic groups, First, infections are more widespread in the African American population at large because partner choice is more highly dissortative-meaning that "peripheral'' African Americans (who have had onl y one partner in the past gear) are five times more likely to choose "core' African Americans (who have had four or more partners in the past year) th an "peripheral" whites are to choose "core" whites, Secondly, sexually tran smitted infections stay within the African American population because thei r partner choices are more segregated (assortative mating) than other group s. The likelihood of African Americans having a sexually transmitted infect ion is 1.3 times greater than it is for whites because of this factor alone .