Social Determinants of Sexual Networks, Partnership Formation, and Sexually Transmitted Infections

Social factors have long been recognized as important determinants of health [ 1 ] . In recent years, social determinants—“the conditions in which people are born, grow, live, work and age, including the health system” (WHO Commission on Social Determinants) [ 2 ] —have attracted increasing attention as fundamental causes of disparities in health status between individuals and populations. Although most studies about social determinants address chronic, non-communicable diseases, a recent examination of the social epidemiology literature from 1975 to 2005 found 44 review articles with infectious disease outcomes, with the majority focused on HIV/AIDS [ 3 ] . The emphasis on HIV is perhaps not surprising, since HIV and other sexually transmitted infections (STI) are by their nature social diseases. Researchers have recently begun to trace the pathways between social determinants and HIV/ STI [ 4– 7 ] . The expression of sexuality, a pervasive in fl uence in human society, is shaped by society. Social factors of all kinds, including those related to education, occupation, neighborhoods, migration, urbanization, mobility, af fl uence, media, religion, substance use, incarceration, and technological change, can in fl uence sexual behaviors, partnership formation, and sexual networks, with resultant effects on STI dissemination. This chapter explores some of the primary modernday social determinants of heterosexual partnering and sexual networks relevant to HIV/STI, particularly in the USA, where STI rates exceed those of all other industrialized countries [ 8 ] .