The Disproportionate High Risk of HIV Infection Am

Authors: Monica A Magadi

Publish Date: 2012/06/04

Volume: 17, Issue: 5, Pages: 1645-1654

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Abstract

The link between HIV infection and poverty in subSaharan Africa SSA is rather complex and findings from previous studies remain inconsistent While some argue that poverty increases vulnerability existing empirical evidence largely support the view that wealthier men and women have higher prevalence of HIV In this paper we examine the association between HIV infection and urban poverty in SSA paying particular attention to differences in risk factors of HIV infection between the urban poor and nonpoor The study is based on secondary analysis of data from the Demographic and Health Surveys from 20 countries in SSA conducted during 20032008 We apply multilevel logistic regression models allowing the urban poverty risk factor to vary across countries to establish the extent to which the observed patterns are generalizable across countries in the SSA region The results reveal that the urban poor in SSA have significantly higher odds of HIV infection than their urban nonpoor counterparts despite poverty being associated with a significantly lower risk among rural residents Furthermore the gender disparity in HIV infection ie the disproportionate higher risk among women is amplified among the urban poor The paper confirms that the public health consequence of urban poverty that has been well documented in previous studies with respect to maternal and child health outcomes does apply to the risk of HIV infection The positive association between household wealth and HIV prevalence observed in previous studies largely reflects the situation in the rural areas where the majority of the SSA populations resideThis study is part of a secondary data analysis project on HIV/AIDS and the well being of children in subSaharan Africa sponsored by the UK Medical Research Council MRC The data used in the analysis were provided by the Demographic and Health Surveys DHS program ICF Macro Calverton Maryland USAThe world’s poorest region subSaharan Africa SSA remains disproportionately affected by HIV/AIDS accounting for about twothirds of HIV infections worldwide and almost threequarters of global AIDSrelated deaths in 2010 1 The relationship between HIV/AIDS and poverty is rather complex Although the link between HIV/AIDS and poverty in SSA has received considerable research attention findings from existing research remain inconsistent While some argue that poverty increases individual vulnerability to HIV infection 2 3 4 empirical evidence largely suggest that men and women living in wealthier households have higher HIV prevalence than those living in poorer ones 5 6 7 8 Studies based on other indicators of socioeconomic status SES also support the view that the risk is likely to be higher among higher SES groups For instance evidence from five countries in East and West Africa suggest a positive education gradient in HIV infection 9 It has been noted that credible evidence exists for both arguments while wealth shows an increased risk for both sexes poverty places women at a special disadvantage 10One possible explanation for the positive association between HIV and poverty is grounded in the theory of economics of sexual behavior—the adverse future life chances of people living in poverty are likely to increase their readiness to take risks today 11 12 In particular women living in deprived urban settings have been observed to engage in riskier sexual behavior than their counterparts in less deprived areas 13 For women living in poverty increased vulnerability has been attributed to possible interaction between poverty and nonbiological factors such as genderbased violence and transactional sex 10 14 15A number of explanations have been proposed for the apparent higher prevalence of HIV among those of higher SES 5 11 It has been argued that being wealthier may lead to reckless lifestyle and risky sexual relationships as wealthier people particularly men tend to attract multiple partners 16 17 18 Shelton and others noted that wealth and social interaction are inextricably linked and wealth might increase the number of opportunities for concurrent heterosexual partnerships to develop 5Another possible explanation for the positive association between wealth and HIV infection relates to higher household wealth among urban residents and higher HIV prevalence in urban areas 5 While this explanation may hold for associations based on bivariate relationships the positive association has been observed to persist even after controlling for urban/rural residence in multivariate analyses 19 implying that there exists other important explanations Also it is possible that the longer survival of wealthier individuals infected with HIV HIV prevalence being partly a function of survival 5 may indeed induce a positive association between wealth and HIVThe positive association between household wealth and HIV prevalence observed in previous studies in SSA is inconsistent with findings for other public health outcomes which have been shown to be relatively poor among lower SES subgroups of the population especially in urban settings The public health consequences of urban poverty under conditions of rapid urban growth have been well documented 20 21 22 23 but there has been scant comparative research on reproductive health inequalities in urban areas especially with respect to HIV/AIDS in SSA Although previous studies highlight the importance of location as a risk factor for HIV incidence in urban settings 24 25 26 little is known about the link between urban poverty and HIV infection in SSA

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