Exploring the connections between HIV serostatus and individual, household, and community socioeconomic resources: Evidence from two population-based surveys in Kenya
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. Social Science [?] Medicine
(Impact Factor: 2.89).
11/2011; 74(2):185-95. DOI: 10.1016/j.socscimed.2011.10.019
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.
Available from: Jeneviève Mannell
- "The material context refers first of all to economic inequalities. Low socio-economic status (SES) has been shown to be associated with HIV status in some settings while high SES is relevant in others [37–39]. For example, people living in conditions of poverty may not prioritize their health, or be able to afford the costs of accessing clinics or adhering to treatment [40, 41]. "
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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.
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.
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.
Available from: Hyppolite K Tchidjou
- "For this reason, people living in disadvantaged areas may have heightened risk of HIV beyond their individual risk factors. It is possible that individual and area level measures of socio-economic-position may influence the rates of progression of HIV in infected subjects and their risk of death (Ishida et al., 2012). Because we do not have data about time since sero-conversion, we cannot distinguish between effects of socio-economic-position on survival and effects on risk of infection. "
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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.
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ABSTRACT: Abstract The aim of this study is to evaluate the characteristics of pregnant women whether they are HIV infected or not and their prenatal care. It is a cross-sectional study. HIV-infected women were derived from a cohort study of all HIV-infected pregnant women followed from 1995 to 2005, at the Instituto de Puericultura e Pediatria Martagão Gesteira - Rio de Janeiro. HIV-non-infected women were derived from a random sample of all pregnant women who gave birth at Rio de Janeiro municipality between 1999 and 2001. All relevant sociodemographic, clinical, and pregnancy outcomes data were retrieved from both studies. To evaluate the prenatal care, we calculated the Kotelchuck Modified Index (KMI). The index is based on the months of initiation of prenatal care and the proportion of visits observed in each trimester, according to gestational age at birth. Comparisons were performed using Student t- and chi-square tests. Variables with p-value < 0.25 were included in an unconditional logistic regression model. There were 713 HIV-infected women and 2145 HIV-non-infected women. Variables independently associated with HIV status were: inadequate KMI (OR=4.08, 95% CI=3.17-5.24); lower educational level (OR=1.32, 95% CI=1.04-1.68); does not live with a partner (OR=3.54, 95% CI=2.66-4.64); lower family income (OR=4.71, 95% CI=3.62-6.14); tobacco use (OR=2.17, 95% CI=1.63-2.88); and hypertension (OR=1.47, 95% CI=1.01-2.17). Prematurity was not independently associated with HIV status. Although in Brazil, the HIV care is free of charge, pregnant women are still having difficulty to reach the specialized care. Better access to care must be offered to this population and studies of prematurity in the HIV-infected women must evaluate their prenatal care.
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