Exploring the connections between HIV serostatus and individual, household, and community socioeconomic resources: Evidence from two population-based surveys in Kenya
ABSTRACT The positive association between health and socioeconomic status (SES) is well documented. However, available empirical evidence on the SES gradients of HIV serostatus is mixed, and few studies have explored the effects of community SES indicators on individual's HIV risk. Using nationally representative data of women and men from the 2003 Demographic and Health Survey and the 2007 AIDS Indicator Survey from Kenya, we assessed the associations between HIV serostatus and SES as measured by educational attainment and household wealth at the individual/household and community levels. Additionally, we explored changes in these associations between 2003 and 2007. Results from bivariate and cohort analyses showed that during this period, HIV burden shifted from higher to lower SES subgroups at both the individual/household and community levels, particularly among women aged 15-24 years. Results from multi-level logistic regression models showed that this shift was generally significant among women. In addition, communities' collective educational attainment, measured as the percentage of residents with some secondary schooling or higher, was a more significant predictor and protective factor for HIV risk than individual/household-level SES indicators for women in 2007 and men in both years. Our findings highlight the relevance of community-level SES to HIV dynamics in Kenya between 2003 and 2007.
- SourceAvailable from: Hyppolite K Tchidjou
Dataset: Cameroon[Show abstract] [Hide abstract]
ABSTRACT: HIV infection prevalence shows strong regional variations in Cameroon, with the North West and the East as the most affected regions. Studies which have attempted to investigate the variation in HIV prevalence in Sub-Saharan countries found that the geographical heterogeneity in Human immunodeficiency virus (HIV) prevalence between high and low prevalence areas still existed after considering the different distribution of unsafe sexual behaviours. Individual and area level socio-economic-positions are both related to HIV transmission but the only study carried out in Cameroon that investigated HIV seroprevalence and socio-economic factors used only individual-based measures. We carried out this study to investigate the full extent of socio-economic influences on HIV sero-prevalence. We analysed data from 4,672 men and 5,227 women, aged 15 to 49, who participated in the Cameroon Demographic and Health survey (CDHS). Among men, HIV risk increased with household wealth at the individual level and there was a positive association between HIV seropositivity and variation in wealth within a region. Among women, there was no evidence of association between living in a relatively disadvantaged region (regional wealth index) and being HIV positive, but HIV seropositivity was associated with variation in wealth within a region. The main direct link between income inequality and HIV is likely to be through transactional sex. High income inequality would stimulate risky sexual behaviours and the diffusion of illicit sexual relationships, especially for wealthy men. Public-health interventions should be carried out, paying particular care in raising the awareness of wealthy men towards less risky sexual behaviours. Policy makers should define intervention strategies to reduce the socio-economic differences within regions.
- [Show abstract] [Hide abstract]
ABSTRACT: Introduction: Contemporary HIV-related theory and policy emphasize the importance of addressing the social drivers of HIV risk and vulnerability for a long-term response. Consequently, increasing attention is being given to social and structural interventions, and to social outcomes of HIV interventions. Appropriate indicators for social outcomes are needed in order to institutionalize the commitment to addressing social outcomes. This paper critically assesses the current state of social indicators within international HIV/AIDS monitoring and evaluation frameworks. Methods: We analyzed the indicator frameworks of six international organizations involved in efforts to improve and synchronize the monitoring and evaluation of the HIV/AIDS response. Our analysis classifies the 328 unique indicators according to what they measure and assesses the degree to which they offer comprehensive measurement across three dimensions: domains of the social context, levels of change and organizational capacity. Results and discussion: The majority of indicators focus on individual-level (clinical and behavioural) interventions and outcomes, neglecting structural interventions, community interventions and social outcomes (e.g. stigma reduction; community capacity building; policy-maker sensitization). The main tool used to address social aspects of HIV/AIDS is the disaggregation of data by social group. This raises three main limitations. Indicator frameworks do not provide comprehensive coverage of the diverse social drivers of the epidemic, particularly neglecting criminalization, stigma, discrimination and gender norms. There is a dearth of indicators for evaluating the social impacts of HIV interventions. Indicators of organizational capacity focus on capacity to effectively deliver and manage clinical services, neglecting capacity to respond appropriately and sustainably to complex social contexts. Conclusions: Current indicator frameworks cannot adequately assess the social outcomes of HIV interventions. This limits knowledge about social drivers and inhibits the institutionalization of social approaches within the HIV/AIDS response. We conclude that indicator frameworks should expand to offer a more comprehensive range of social indicators for monitoring and evaluation and to include indicators of organizational capacity to tackle social drivers. While such expansion poses challenges for standardization and coordination, we argue that the complexity of interventions producing social outcomes necessitates capacity for flexibility and local tailoring in monitoring and evaluation.Journal of the International AIDS Society 08/2014; 17(1):19073. DOI:10.7448/IAS.17.1.19073 · 4.21 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Within sub-Saharan Africa, women are disproportionately at risk for acquiring and having human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). It is important to clarify whether gender inequalities in HIV prevalence in this region are explained by differences in the distributions of HIV risk factors, differences in the effects of these risk factors or some combination of both. We used an extension of the Blinder-Oaxaca decomposition approach to explain gender inequalities in HIV/AIDS in Kenya, Lesotho and Tanzania using data from the demographic and health and AIDS indicator surveys. After adjusting for covariates using Poisson regression models, female gender was associated with a higher prevalence of HIV/AIDS in Kenya [prevalence ratio (PR) = 1.73, 95% confidence interval (CI) = 1.33, 2.23 in 2003] and Lesotho (PR = 1.39, 95% CI = 1.20, 1.62 in 2004/05), but not in Tanzania. Decomposition analyses demonstrated two distinct patterns over time. In Tanzania, the gender inequality in HIV/AIDS was explained by differences in the distributions of HIV risk factors between men and women. In contrast, in Kenya and Lesotho, this inequality was partly explained by differences in the effects across men and women of measured HIV/AIDS risk factors, including socio-demographic characteristics (age and marital status) and sexual behaviours (age at first sex); these results imply that gender inequalities in HIV/AIDS would persist in Kenya and Lesotho even if men and women had similar distributions of HIV risk factors. The production of gender inequalities may vary across countries, with inequalities attributable to the unequal distribution of risk factors among men and women in some countries and the differential effect of these factors between groups in others. These different patterns have important implications for policies to reduce gender inequalities in HIV/AIDS.Health Policy and Planning 12/2013; 29(7). DOI:10.1093/heapol/czt075 · 3.00 Impact Factor