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HIV infection does not disproportionately affect the poorer in sub-Saharan Africa

Mishra, Vinoda; Assche, Simona Bignami-Vanb; Greener, Robertc; Vaessen, Martina; Hong, Rathavutha; Ghys, Peter Dc; Boerma, J Tiesd; Van Assche, Arie; Khan, Shanea; Rutstein, Sheaa

doi: 10.1097/01.aids.0000300532.51860.2a

Background: Wealthier populations do better than poorer ones on most measures of health status, including nutrition, morbidity and mortality, and healthcare utilization.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

From the aMacro International Inc., Calverton, Maryland, USA

bUniversity of Montreal, Montreal, Canada

cJoint United Nations Programme on HIV/AIDS, Geneva, Switzerland

dWorld Health Organization, Geneva, Switzerland

eHEC Montreal, Montreal, Canada.

Correspondence to Vinod Mishra, DHR Division, Macro International Inc., 11785 Beltsville Drive, Calverton, MD 20705, USA. Tel: +1 301 572 0220; fax: +1 301 572 0999; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.