The Socioeconomic Determinants of HIV Incidence: Evidence from a Longitudinal, Population-Based Study in Rural South Africa

Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
AIDS (London, England) (Impact Factor: 5.55). 12/2007; 21 Suppl 7(Suppl 7):S29-38. DOI: 10.1097/01.aids.0000300533.59483.95
Source: PubMed


Knowledge of the effect of socioeconomic status on HIV infection in Africa stems largely from cross-sectional studies. Cross-sectional studies suffer from two important limitations: two-way causality between socioeconomic status and HIV serostatus and simultaneous effects of socioeconomic status on HIV incidence and HIV-positive survival time. Both problems are avoided in longitudinal cohort studies.
We used data from a longitudinal HIV surveillance and a linked demographic surveillance in a poor rural community in KwaZulu-Natal, South Africa, to investigate the effect of three measures of socioeconomic status on HIV incidence: educational attainment, household wealth categories (based on a ranking of households on an assets index scale) and per capita household expenditure. Our sample comprised of 3325 individuals who tested HIV-negative at baseline and either HIV-negative or -positive on a second test (on average 1.3 years later).
In multivariable survival analysis, one additional year of education reduced the hazard of acquiring HIV by 7% (P = 0.017) net of sex, age, wealth, household expenditure, rural vs. urban/periurban residence, migration status and partnership status. Holding other factors equal, members of households that fell into the middle 40% of relative wealth had a 72% higher hazard of HIV acquisition than members of the 40% poorest households (P = 0.012). Per capita household expenditure did not significantly affect HIV incidence (P = 0.669).
Although poverty reduction is important for obvious reasons, it may not be as effective as anticipated in reducing the spread of HIV in rural South Africa. In contrast, our results suggest that increasing educational attainment in the general population may lower HIV incidence.

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Available from: Victoria Hosegood, Jan 06, 2014
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    • "In this article I examine the production of new modes of calculation, calibration and measurement of bodies at work in the timber plantations of northern KwaZulu-Natal, South Africa — modes that echo older, diverse technologies of self and health while producing new ways of talking about the body and its social context. From 2009, all 10 000 labourers working for one of South Africa's largest paper and pulp companies began receiving a calculated set of calories and micronutrients in the form of a cooked meal because it was becoming clear that their productivity as a workforce was declining as the ripple effects of a generalised HIV epidemic began to be felt in all aspects of everyday life (Bärnighausen et al. 2007; Crush, Frayne and Grant 2006; De Waal 2003; Simtowe, Islam and Kinkingninhoun-Medagbe 2011). "
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    ABSTRACT: The article examines the production of new modes of calculation, calibration and measurement of bodies at work in the timber plantations of northern KwaZulu-Natal, South Africa — modes that echo older, diverse technologies of self and health while producing new ways of talking about the body and its social context. I describe two sets of substances that augment wellbeing for those who work the plantations, one in the form of a nutrition intervention and the other a class of popular curatives that operate in the registers of traditional medicine, vitamin supplement, and herbal tonic. I track the concepts and techniques of measurement, calibration and intervention in this locale in order to understand how they employ and generate ideas about culture, history, and wellbeing to produce new populations available for labour — as timber plantation labourers and as compliant HIV surveillance subjects.
    04/2014; 37(1-2):30-41. DOI:10.1080/23323256.2014.940191
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    • "Fifteen studies, including multicountry analyses, demonstrate the strong link between increasing educational attainment and reduction in risk of HIV [88, 92–102] (works), along with abolishing school fees [103, 104] (works) and conditional cash transfers [105] (promising). For example, multivariate survival analysis in South Africa showed that one additional year of education reduced the hazard of acquiring HIV by 7% net of sex, age, wealth, household expenditure, residence, migration status and partnership status [94]. A 2009 study in Ethiopia, Ghana, Kenya, Malawi and Mozambique showed that fee abolition resulted in an average 23% increase in total enrolment across the five countries [103]. "
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    ABSTRACT: There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women's employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows' ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.
    Journal of the International AIDS Society 01/2014; 17(1):18619. DOI:10.7448/IAS.17.1.18619 · 5.09 Impact Factor
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    • "The increase in rates of condom use among later birth cohorts is in accordance with nationally representative data on this metric [9]. Increased levels of education may be associated with a decline in the risk of acquiring HIV [8,10]. However, this younger cohort also had a lower age at first sex compared to those born earlier. "
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    ABSTRACT: Objective To describe and quantify the differences in risk behaviours, HIV prevalence and incidence rates by birth cohorts among a group of women in Durban, South Africa. Methods Cross-sectional and prospective cohort analyses were conducted for women who consented to be screened and enrolled in an HIV prevention trial. Demographic and sexual behaviours were described by five-year birth cohorts. Semiparametric regression models were used to investigate the bivariate associations between these factors and the birth cohorts. HIV seroconversion rates were also estimated by birth cohorts. Results The prevalence of HIV-1 infection at the screening visit was lowest (20.0%) among the oldest (born before 1960) cohorts, while the highest prevalence was observed among those born between 1975 and 79. Level of education increased across the birth cohorts while the median age at first sexual experience declined among those born after 1975 compared to those born before 1975. Only 33.03% of the oldest group reported ever using a condom while engaging in vaginal sex compared to 73.68% in the youngest group; however, HIV and other sexually transmitted infection (STI) incidence rates were significantly higher among younger women compared to older women. Conclusions These findings clearly suggest that demographic and sexual risk behaviours are differentially related to the birth cohorts. Significantly high HIV and STI incidence rates were observed among the younger group. Although the level of education increased, early age at sexual debut was more common among the younger group. The continuing increase in HIV and STI incidence rates among the later cohorts suggests that the future trajectory of the epidemic will be dependent on the infection patterns in younger birth cohorts.
    Journal of the International AIDS Society 11/2013; 16(1):18589. DOI:10.7448/IAS.16.1.18589 · 5.09 Impact Factor
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