Article

‘HIV Infection Does Not Disproportionately Affect the Poorer in Sub-Saharan Africa’

Macro International Inc., Calverton, Maryland, USA.
AIDS (London, England) (Impact Factor: 5.55). 12/2007; 21 Suppl 7(Suppl 7):S17-28. DOI: 10.1097/01.aids.0000300532.51860.2a
Source: PubMed

ABSTRACT

Wealthier populations do better than poorer ones on most measures of health status, including nutrition, morbidity and mortality, and healthcare utilization.
This study examines the association between household wealth status and HIV serostatus to identify what characteristics and behaviours are associated with HIV infection, and the role of confounding factors such as place of residence and other risk factors.
Data are from eight national surveys in sub-Saharan Africa (Kenya, Ghana, Burkina Faso, Cameroon, Tanzania, Lesotho, Malawi, and Uganda) conducted during 2003-2005. Dried blood spot samples were collected and tested for HIV, following internationally accepted ethical standards and laboratory procedures. The association between household wealth (measured by an index based on household ownership of durable assets and other amenities) and HIV serostatus is examined using both descriptive and multivariate statistical methods.
In all eight countries, adults in the wealthiest quintiles have a higher prevalence of HIV than those in the poorer quintiles. Prevalence increases monotonically with wealth in most cases. Similarly for cohabiting couples, the likelihood that one or both partners is HIV infected increases with wealth. The positive association between wealth and HIV prevalence is only partly explained by an association of wealth with other underlying factors, such as place of residence and education, and by differences in sexual behaviour, such as multiple sex partners, condom use, and male circumcision.
In sub-Saharan Africa, HIV prevalence does not exhibit the same pattern of association with poverty as most other diseases. HIV programmes should also focus on the wealthier segments of the population.

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    • "6. We note, however, that emerging evidence gleaned from Demographic and Health Surveys (DHS) in select African nations questions this basic logic (see, for example, Fox 2010; Mishra et al. 2007; Parkhurst 2010). These findings point to higher risk of HIV infection among men and women in the wealthiest income quartiles who are speculated to have the resources to support multiple partners and a desire to accrue material assets from multiple partners, respectively. "
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    • "Nevertheless, studies during the early stage of the epidemic suggested that HIV incidence initially occurred not amongst the poorest, but among better off members of society in this region. A decade later, infections still appear more concentrated among the urban employed and more mobile members of society, and consequently the wealthier groups (Mishra, et.al., 2007). There is however, no result that the AIDS/HIV infection has strong association with low socio-economic status and poverty. "
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    • "In a recent supplement to the Journal of the International AIDS Society devoted entirely to structural drivers of HIV transmission, Seeley et al. (2012) noted that elimination of HIV will require 'a comprehensive HIV response, that includes meaningful responses to the social, political, economic and environmental factors that affect HIV risk and vulnerability'. Also, a prevailing view emphasizes the role of poverty in the spread of HIV, despite numerous studies demonstrating an inverse relationship between HIV serostatus and poverty status in sub-Saharan Africa, which is opposite to the case in the developed world and contrary to common expectations about disease susceptibility and poverty status (Shelton et al., 2005; Gillespie et al., 2007; Mishra et al., 2007; Parkhurst, 2010). Commenting in The Lancet, Shelton et al. (2005, p. 1058) suggested that both wealth and economic disadvantage may play pivotal roles in HIV transmission through sexual concurrency networks, with wealth being 'associated with the mobility, time, and resources to maintain concurrent partnerships' and where women 'might improve their economic situation by having more than one concurrent partner.' "
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