Racial/ethnic homophily in sexual partnerships (partners share the same race/ethnicity) has been associated with racial/ethnic disparities in HIV. Structural racism may partly determine racial/ethnic homophily in sexual partnerships. This study estimated associations of racial/ethnic concentration and mortgage discrimination against Black and Latino residents with racial/ethnic homophily in sexual partnerships among 7847 people who inject drugs (PWID) recruited from 19 US cities to participate in CDC’s National HIV Behavioral Surveillance. Racial/ethnic concentration was defined by two measures that respectively compared ZIP code-level concentrations of Black residents to White residents and Latino residents to White residents, using the Index of Concentration at the Extremes. Mortgage discrimination was defined by two measures that respectively compared county-level mortgage loan denial among Black applicants to White applicants and mortgage loan denial among Latino applicants to White applicants, with similar characteristics (e.g., income, loan amount). Multilevel logistic regression models were used to estimate associations. Interactions of race/ethnicity with measures of racial/ethnic concentration and mortgage discrimination were added to the final multivariable model and decomposed into race/ethnicity-specific estimates. In the final multivariable model, among Black PWID, living in ZIP codes with higher concentrations of Black vs. White residents and counties with higher mortgage discrimination against Black residents was associated with higher odds of homophily. Living in counties with higher mortgage discrimination against Latino residents was associated with lower odds of homophily among Black PWID. Among Latino PWID, living in ZIP codes with higher concentrations of Latino vs. White residents and counties with higher mortgage discrimination against Latino residents was associated with higher odds of homophily. Living in counties with higher mortgage discrimination against Black residents was associated with lower odds of homophily among Latino PWID. Among White PWID, living in ZIP codes with higher concentrations of Black or Latino residents vs. White residents was associated with lower odds of homophily, but living in counties with higher mortgage discrimination against Black residents was associated with higher odds of homophily. Racial/ethnic segregation may partly drive same race/ethnicity sexual partnering among PWID. Future empirical evidence linking these associations directly or indirectly (via place-level mediators) to HIV/STI transmission will determine how eliminating discriminatory housing policies impact HIV/STI transmission.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Racial/ethnic disparities in diagnoses of HIV/AIDS--33 states, 2001-2004. . MMWR Morbidity Mortality Weekly Report, 2006. 55(5): p. 121-125.
Mitsch AJ, Hall HI, Babu AS. Trends in HIV infection among persons who inject drugs: United States and Puerto Rico, 2008–2013. Am J Public Health. 2016;106(12):2194–201.
Wejnert C, Hess KL, Hall HI, van Handel M, Hayes D, Fulton P Jr, et al. Vital signs: trends in HIV diagnoses, risk behaviors, and prevention among persons who inject drugs - United States. MMWR Morbidity Mortality Weekly Report. 2016;65(47):1336–42.
Burnett JC, Broz D, Spiller MW, Wejnert C, Paz-Bailey G. HIV infection and HIV-associated behaviors among persons who inject drugs - 20 cities, United States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67(1):23–8.
Hill MJ, Holt M, Hanscom B, Wang Z, Cardenas-Turanzas M, Latkin C. Gender and race as correlates of high risk sex behaviors among injection drug users at risk for HIV enrolled in the HPTN 037 study. Drug Alcohol Depend. 2018;183:267–74.
Laumann EO, Youm Y. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sex Transm Dis. 1999;26(5):250–61.
Williams C, et al. Racial disparities in HIV prevalence and risk behaviors among injection drug users and members of their risk networks. J Acquir Immune Defic Syndr. 2013;63
Linton SL, Celentano DD, Kirk GD, Mehta SH. The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore. MD Drug Alcohol Depend. 2013;132(3):457–65.
Momplaisir F, et al. Racial inequities in HIV prevalence and composition of risk networks among people who inject drugs in HIV Prevention Trial Network 037. J Acquir Immune Defic Syndr. 2017;76(4):394–401.
Adimora AA, Schoenbach VJ. Contextual factors and the black-white disparity in heterosexual HIV transmission. Epidemiology. 2002;13(6):707–12.
Kottiri BJ, Friedman SR, Neaigus A, Curtis R, Des Jarlais DC. Risk networks and racial/ethnic differences in the prevalence of HIV infection among injection drug users. J Acquir Immune Defic Syndr. 2002;30(1):95–104.
Finer LB, Darroch JE, Singh S. Sexual partnership patterns as a behavioral risk factor for sexually transmitted diseases. Fam Plan Perspect. 1999;31(5):228–36.
DiPrete TA, et al. Segregation in social networks based on acquaintanceship and trust. Am J Sociol. 2011;116(4):1234–83.
Marsden PV. Social trends in American life: findings from the General Social Survey since 1972. Princeton University Press: Princeton; 2012.
Lacayo C. Latinos need to stay in their place: differential segregation in a multi-ethnic suburb. Societies. 2016;6(3):25–42.
Adimora AA, Schoenbach VJ. Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. J Infect Dis. 2005;191(Suppl 1):S115–22.
Cooper HL, et al. Public housing relocations and partnership dynamics in areas with high prevalences of sexually transmitted infections. Sex Transm Dis. 2016;43(4):222–30.
Lutfi K, Trepka MJ, Fennie KP, Ibanez G, Gladwin H. Racial residential segregation and risky sexual behavior among non-Hispanic Blacks, National Survey of Family Growth, 2006 – 2010. Soc Sci Med. 2015;140:95–103.
Gindi RM, et al. The geography of heterosexual partnerships in Baltimore City adults. Sex Transm Dis. 2011;38(4):260–6.
Rothenberg R, Muth SQ, Malone S, Potterat JJ, Woodhouse DE. Social and geographic distance in HIV risk. Sex Transm Dis. 2005;32(8):506–12.
Pietila, A., Not in my neighborhood: how bigotry shaped a great American City. 2012: Ivan R Dee, Incorporated.
Pager D, Shepherd H. The sociology of discrimination: racial discrimination in employment, housing, credit, and consumer markets. Annu Rev Sociol. 2008;34:181–209.
Turner M, et al. Housing discrimination against racial and ethnic minorities 2012. Washington: The Urban Institute; 2013.
Hartman, C., City for sale: the transformation of San Francisco. 2002: University of California Press.
Reardon SF, Fox L, Townsend J. Neighborhood income composition by household age and income, 1990–2009. Ann Am Acad Pol Soc Sci. 2015;660(1):78–97.
Wilson WJ. When work disappears : the world of the new urban poor. New York: Knopf : Distributed by Random House; 1997.
Greer S, Kramer MR, Cook-Smith JN, Casper ML. Metropolitan racial residential segregation and cardiovascular mortality: exploring pathways. J Urban Health. 2014;91(3):499–509.
Rosenblum D, Castrillo FM, Bourgois P, Mars S, Karandinos G, Unick GJ, et al. Urban segregation and the US heroin market: a quantitative model of anthropological hypotheses from an inner-city drug market. Int J Drug Policy. 2014;25(3):543–55.
Halpern D. Minorities and mental health. Soc Sci Med. 1993;36(5):597–607.
Lee MA, Ferraro KF. Neighborhood residential segregation and physical health among Hispanic Americans: good, bad, or benign? J Health Soc Behav. 2007;48(2):131–48.
Inagami S, Borrell LN, Wong MD, Fang J, Shapiro MF, Asch SM. Residential segregation and Latino, Black and White mortality in New York City. J Urban Health. 2006;83(3):406–20.
Kershaw KN, et al. Neighborhood-level racial/ethnic residential segregation and incident cardiovascular disease: the multi-ethnic study of atherosclerosis. Circulation. 2015;131(2):141–8.
Kramer MR, Cooper HL, Drews-Botsch CD, Waller LA, Hogue CR. Metropolitan isolation segregation and Black–White disparities in very preterm birth: a test of mediating pathways and variance explained. Soc Sci Med. 2010;71(12):2108–16.
Buot M-LG, et al. Beyond race and place: distal sociological determinants of HIV disparities. PLoS One. 2014;9(4):e91711.
Ibragimov U, et al. Relationship of racial residential segregation to newly diagnosed cases of HIV among Black heterosexuals in US metropolitan areas, 2008-2015. J Urban Health. 2018;
Bower KM, Thorpe RJ Jr, Yenokyan G, McGinty E, Dubay L, Gaskin DJ. Racial residential segregation and disparities in obesity among women. J Urban Health. 2015;92(5):843–52.
Pugsley RA, Chapman DA, Kennedy MG, Liu H, Lapane KL. Residential segregation and gonorrhea rates in US metropolitan statistical areas, 2005-2009. Sex Transm Dis. 2013;40(6):439–43.
Biello KB, Kershaw T, Nelson R, Hogben M, Ickovics J, Niccolai L. Racial residential segregation and rates of gonorrhea in the United States, 2003-2007. Am J Public Health. 2012;102(7):1370–7.
Chang VW. Racial residential segregation and weight status among US adults. Soc Sci Med. 2006;63(5):1289–303.
Cooper HLF, et al. Racialized risk environments in a large sample of people who inject drugs in the United States. Int J Drug Policy. 2016;27:43–55.
Acevedo-Garcia D. Residential segregation and the epidemiology of infectious diseases. Soc Sci Med. 2000;51(8):1143–61.
Osypuk TL, Bates LM, Acevedo-Garcia D. Another Mexican birthweight paradox? The role of residential enclaves and neighborhood poverty in the birthweight of Mexican-origin infants. Soc Sci Med. 2010;70(4):550–60.
Do DP, Frank R, Zheng C, Iceland J. Hispanic segregation and poor health: it's not just Black and White. Am J Epidemiol. 2017;186(8):990–9.
A compass for understanding and using American Community Survey Data. 2008, U.S. Census Bureau: Washington, DC.
Gallagher KM, et al. Behavioral surveillance among people at risk for HIV infection in the U.S.: the National HIV Behavioral Surveillance System. Public Health Rep. 2007;122((1_suppl)):32–8.
CDC, HIV/AIDS Surveillance Report. 2008, Department of Health and Human Services, Centers for Disease Control and Prevention: Atlanta, GA.
Spiller MW, Broz D, Wejnert C, Nerlander L, Paz-Bailey G, Centers for Disease Control and Prevention (CDC), et al. HIV infection and HIV-associated behaviors among persons who inject drugs - 20 cities, United States, 2012. MMWR Morb Mortal Wkly Rep. 2015;64(10):270–5.
Feldman JM, Waterman PD, Coull BA, Krieger N. Spatial social polarisation: using the index of concentration at the extremes jointly for income and race/ethnicity to analyse risk of hypertension. J Epidemiol Community Health. 2015;69(12):1199–207.
Krieger N, Waterman PD, Spasojevic J, Li W, Maduro G, van Wye G. Public health monitoring of privilege and deprivation with the index of concentration at the extremes. Am J Public Health. 2016;106(2):256–63.
Massey, D., The prodigal paradigm returns: ecology comes back to sociology, in does it take a village? Community effects on children, adolescents, and families., A. Booth and A. Crouter, Editors. 2001, Lawrence Erlbaum Associates: Mahwah, New Jerseyp 41-48.
Krieger N, Feldman JM, Waterman PD, Chen JT, Coull BA, Hemenway D. Local residential segregation matters: stronger association of census tract compared to conventional city-level measures with fatal and non-fatal assaults (total and firearm related), using the index of concentration at the extremes (ICE) for racial, economic, and racialized economic segregation, Massachusetts (US), 1995-2010. J Urban Health. 2017;94(2):244–58.
Gee GC. A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. Am J Public Health. 2002;92(4):615–23.
Mendez DD, Hogan VK, Culhane JF. Institutional racism, neighborhood factors, stress, and preterm birth. Ethn Health. 2014;19(5):479–99.
Neaigus A, Jenness SM, Reilly KH, Youm Y, Hagan H, Wendel T, et al. Community sexual bridging among heterosexuals at high-risk of HIV in New York City. AIDS Behav. 2016;20(4):722–36.
Bowman NA, Stewart DL. Precollege exposure to racial/ethnic difference and first-year college students' racial attitudes. Teach Coll Rec. 2014;116(10):1–20.
Fischer MJ. Does campus diversity promote friendship diversity? A look at interracial friendships in college. Soc Sci Q. 2008;89(3):631–55.
Allport GW, The nature of prejudice. Garden City. NY: Doubleday; 1958.
Hartigan J. Green ghettos and the white underclass. Soc Res. 1997;64(2):339–65.
McDermott M, Samson FL. White racial and ethnic identity in the United States. Annu Rev Sociol. 2005;31:245–61.
Livingston, G. and A. Brown, Intermarriage in the U.S. 50 years after Loving v. Virginia. 2017, Pew Research Center
Bluthenthal RN, Do DP, Finch B, Martinez A, Edlin BR, Kral AH. Community characteristics associated with HIV risk among injection drug users in the San Francisco Bay Area: a multilevel analysis. J Urban Health. 2007;84(5):653–66.
Friedman SR, Young PA, Snyder FR, Shorty V, Jones A, Estrada AL. Racial differences in sexual behaviors related to AIDS in a nineteen-city sample of street-recruited drug injectors. NADR Consortium AIDS Educ Prev. 1993;5(3):196–211.
Linton SL, Cooper HL, Kelley ME, Karnes CC, Ross Z, Wolfe ME, et al. HIV infection among people who inject drugs in the United States: geographically explained variance across racial and ethnic groups. Am J Public Health. 2015;105(12):2457–65.
Draus P, Roddy J, Greenwald M. Heroin mismatch in the Motor City: addiction, segregation, and the geography of opportunity. J Ethn Subst Abus. 2012;11(2):149–73.
Rothenberg RB, Potterat JJ. Temporal and social aspects of gonorrhea transmission: the force of infectivity. Sex Transm Dis. 1988;15(2):88–92.
An Q, et al. An innovative approach to assess similarity between sex partners. AIDS Behav. 2018;
Hoover DR, et al. Repeated measures regression in laboratory, clinical and environmental research: common misconceptions in the matter of different within- and between-subject slopes. Int J Environ Res Public Health. 2019;16(3):504.
Kleit RG, Galvez M. The location choices of public housing residents displaced by redevelopment: market constraints, personal preferences, or social information. J Urban Aff. 2011;33(4):375–407.
Jan, T., Ben Carson’s HUD dials back investigations into housing discrimination, in The Washington Post. 2018: Washington, DC.
Meckler, L. and D. Barrett, Trump administration considers rollback of anti-discrimination rules, in The Washington Post. 2019: Washington, DC.
This work was supported by three grants from the National Institutes of Health [grant numbers: R01 DA035101, R01 DA046197 and P30 AI050409] and from the National Institute on Minority Health and Health Disparities [L60 MD009245]. We thank the Centers for Disease Control and Prevention and the National HIV Behavioral Surveillance System Study Group—Atlanta, GA, Jeff Todd and Greg Bautista; Baltimore, MD, Colin Flynn and Danielle German; Boston, MA, Maura Miminos, Rose Doherty, and Chris Wittke; Chicago, IL, Nikhil Prachand and Nanette Benbow; Dallas, TX, Sharon Melville, Shane Sheu, and Alicia Novoa; Denver, CO, Mark Thrun, Alia Al-Tayyib, and Ralph Wilmoth; Detroit, MI, Vivian Griffin, Emily Higgins, and Karen MacMaster; Houston, TX, Marcia Wolverton, Hafeez Rehman, and Paige Padgett; Los Angeles, CA, Trista Bingham and Ekow Kwa Sey; Miami, FL, Marlene LaLota, Lisa Metsch, and David Forrest; Nassau-Suffolk, NY, Bridget Anderson, P. Tyler French, and Lou Smith; New Orleans, LA, DeAnn Gruber, William T. Robinson, and Narquis Barak; New York City, NY, Alan Neaigus, Kathleen H. Reilly, and Travis Wendel; Newark, NJ, Barbara Bolden, Afework Wogayehu, and Henry Godette; Philadelphia, PA, Kathleen A. Brady and Jennifer Shinefeld; San Diego, CA, Vanessa Miguelino-Keasling and Veronica Tovar; San Francisco, CA, H. Fisher Raymond; San Juan, PR, Sandra Miranda De León, Yadira Rolón-Colón, and Melissa Marzan; Seattle, WA, Tom Jaenicke, Hanne Thiede, and Richard Burt; Washington, DC, Manya Magnus, Irene Kuo, and Tiffany West; and CDC, Alexandra Balaji, Laura Cooley, Melissa Cribbin, Paul Denning, Casey Eastman, Teresa Finlayson, Kathy Hageman, Wade Ivy, Nevin Krishna, Binh Le, Tricia Martin, Isa Miles, Alexandra Oster, Huong Pham, Brittani Robinson, Kathryn Salo, Catlainn Sionean, Amanda Smith, April Smith, Roy Smoot, Michael Spiller, Anissa Walker, and Wei Zhang. We acknowledge Mary E Kelley, Behzad Kianian, and Stephanie Beane for contributing to developing the analytic plan, conducting analysis, and interpreting results. We also extend our gratitude to the men and women who participated in NHBS and the staff at all NHBS sites.
The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Linton, S.L., Cooper, H.L., Chen, Y. et al. Mortgage Discrimination and Racial/Ethnic Concentration Are Associated with Same-Race/Ethnicity Partnering among People Who Inject Drugs in 19 US Cities. J Urban Health (2020) doi:10.1007/s11524-019-00405-w
- Racial/ethnic disparities
- People who inject drugs
- Sexual partnerships