Relative Deprivation, Sexually Transmitted Diseases and HIV and AIDS Mortality: A Multilevel Analysis

Objectives: Previous studies on the covariates of sexually transmitted diseases have concentrated on absolute deprivation, often measured by poverty. The aim of this study was to examine the association between relative deprivation (income inequality) and sexually transmitted diseases, and HIV and AIDS mortality. Method: Ecological data based on 3080 counties were obtained from the Area Resource File. State level data on the 50 states and the District of Columbia were derived from the Statistical Abstract of the United States. Multilevel generalized linear models were fitted to the data. Results: State level relative deprivation (measured as the Gini coefficient of income inequality) was strongly and significantly associated with both sexually transmitted diseases (b=12.96, t=4.27, p=.000), and HIV and AIDS mortality (b=20.41, t=5.58, p=.000). Absolute deprivation (poverty) was also associated with sexually transmitted diseases, but the association was not as strong as that of relative deprivation. Furthermore, poverty was not significantly associated with HIV and AIDS mortality at the county level. Conclusion: It was concluded that to reduce sexually transmitted diseases and HIV/AIDS, attention should be placed on combating economic inequality and poverty. One tack is to reduce social marginalization of segments of the