Mortgage Discrimination and Racial/Ethnic Concentration Are Associated with Same-Race/Ethnicity Partnering among People Who Inject Drugs in 19 US Cities


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.

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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.

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Correspondence to Sabriya L. Linton.

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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

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  • Discrimination
  • HIV
  • Racial/ethnic disparities
  • People who inject drugs
  • Segregation
  • Sexual partnerships