Inequality more relevant than Poverty for HIV in Africa

Now here is an article was sufficiently interesting to raise me from my publishing lethargy and get me to WordPress.  The research focuses on socioeconomic correlates of HIV in Africa.  It follows from past research suggesting that wealth/poverty is not driving the epidemic, as rates are (at least initially) higher amongst well-off persons in this continent.

For her dissertation, on which this paper is based, Dr Fox (no, not that one) dug into the DHS datasets from across sub-Saharan Africa and built a mammoth of a multilevel model that allowed for individual, regional and national level income wealth and wealth inequality.

There are many interesting findings in the paper, but I wanted to highlight two.  First, the headline result is that regional inequality predicts HIV infection net of personal wealth, although it is not strongly mediated by circumcision or sexual behaviour.  This is of great interest to me as someone with a working interest in the impact and mechanisms of inequality on sexually transmitted diseases, although it does beg the question of what the causal mechanisms (or confounders) might be.

Perhaps more interesting, however, is found in the nuance seen when stratifying by regional wealth:

The findings also reveal a paradox that supports a dynamic interpretation of epidemic trends: in wealthier regions/countries, individuals with less wealth were more likely to be infected with HIV, whereas in poorer regions/countries, individuals with more wealth were more likely to be infected with HIV.

I read this as supporting the idea of connectivity being key to getting one into the sexual networks that put one at risk, and the idea that having resources (e.g. wealth, knowledge) once in this network is key to reducing the risk (either by leaving the network or protecting yourself within it).  Note that ‘wealthier regions’ tends to mean urban, often capital.

There is a lot more work to be done on the dynamics of the relationship between socioeconomic factors and HIV infection, but this is an important step along the road.

Citation: Fox, AM. The HIV-poverty thesis re-examined: Poverty, wealth or inequality as a social determinant of HIV infection in sub-Saharan Africa? Journal of Biosocial Sciences, epub ahead of print. doi:10.1017/S0021932011000745 . Link.