Online Program

Conflict, substance use and HIV: A global analysis

Tuesday, November 3, 2015 : 9:30 a.m. - 9:50 a.m.

Bradley Kerridge, Ph.D. Epidemiology, Mailman School of Public Health, Department of Epidemiology, Columbia University, Gaithersburg, MD
Deborah S. Hasin, PhD, Columbia University/New York State Psychiatric Institute, New York, NY
This study developed and tested a longitudinal explanatory model of the relationship between conflict (between 2002-2008) and HIV disability-adjusted life years (DALYs) among WHO Member States.  This model differentiated between pre-existing background susceptibility factors and vulnerability factors that serve as moderating and mediating processes, respectively, through which conflict affects HIV morbidity/mortality.  Data on conflict, 2010 HIV attributable DALYs and susceptibility and vulnerability factors consisted of country-level data assembled from multiple sources.  Partial least squares structural equation modeling was used to test the model.  The first susceptibility construct (per capita alcohol consumption, injection drug use prevalence and illicit drug use prevalence indicators) served as a moderator of the conflict-HIV association (t = 1.74, p < 0.05) while the second susceptibility construct (ethnic heterogeneity, baseline HIV prevalence and natural disaster indicators) directly served to increase HIV DALYs (t = 6.52, p < 0.05).  The vulnerability construct consisting of the number of people on ART, total spending on HIV and number of refugees, was shown to mediate the conflict-HIV association (conflict → vulnerability construct; t = 6.62, p < 0.05; vulnerability construct → HIV DALYs, t = 8.65, p < 0.05).  This study suggested that HIV interventions for conflict prone states include programs to reduce rates of alcohol use/illicit drug use, to reduce impact of natural disasters and conflict on the populace, especially refugees and to address inequality resulting from discrimination.  The results suggest global-wide attention to HIV and TB drug resistance in the form of surveillance and treatment.

Learning Areas:

Advocacy for health and health education
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the relationship between conflict and HIV morbidity and mortality in WHO Member States. Identify mediators and moderators of the conflict-HIV relationship. Describe how structural equation modeling can be used to understand causal pathways between social, economic, cultural, behavioral and health determinants and major infectious diseases.

Keyword(s): HIV/AIDS, Drug Abuse

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a PhD and years of experience conducting research in the realm of HIV.I am the principal investigator on my Individual NRSA Postdoctoral Fellowship from the National Institutes of Health (NIDA) focusing on the epidemiology of HIV and drug abuse and conflict.
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.