190435 Poverty or inequality as an underlying cause of HIV in Africa? The HIV-poverty thesis re-examined

Monday, October 27, 2008

Ashley Fox, MA , Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
Background: Explanations for Africa's disproportionate burden of HIV/AIDS have been linked to the continent's endemic poverty. However, contrary to theories of poverty as the underlying cause of HIV in Africa, an increasing body of evidence at the national and individual levels indicates that wealthier countries in Africa, and wealthier individuals within countries, are at heightened risk for HIV. This study will test the hypothesis that rather than HIV being a disease associated with poverty, HIV infection increases under conditions of rising socio-economic inequality.

Methods: Examining demographic and health survey data from six African countries (Zimbabwe, Lesotho, Tanzania, Kenya, Ivory Coast and Ghana), this study utilizes a multi-level model of the relationship between HIV infection and economic inequality. Bivariate relationships between the outcome measure (HIV serostatus) and economic inequality at the regional level were assessed within each of the six countries. All multivariate models were run as a two-level, hierarchical random coefficient models in Stata adjusted for clustering at the regional level.

Results: Within each country, regional HIV prevalence was positively correlated with regional economic inequality reaching statistical significance in Ghana and Lesotho (p<0.1). Results from the two-level random intercept model demonstrated that individual wealth quintile and regional gini coefficient are positive and significant (p<0.01). As hypothesized, taking advantage of the pooling of data reveals that wealthier individuals, rather than poorer individuals as commonly thought, are at higher risk for HIV infection and that the probability of infection increases with rising regional (within-country) inequality.

Learning Objectives:
1. Define the distinctions among absolute poverty, relative poverty and inequality and the effect of these distinct constructs on HIV risk in poor countries. 2. Articulate the contextual factors that influence HIV prevalence across countries. 3. Evaluate the relationship among poverty, inequality and HIV risk in sub-Saharan Africa.

Keywords: HIV/AIDS, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I will be presenting my dissertation work and have presented on other topics at APHA in the past.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.