Is HIV infection associated with poverty? Are there other factors involved in this possible association? These are questions that exercise the minds of at least one person (and in reality many more) in the world today.
Middle- and low-income regions are the areas hardest hit by the HIV epidemic
Middle- and low-income regions are the areas hardest hit by the HIV epidemic, especially countries in sub-Saharan Africa. Two fundamental factors that influence the distribution of HIV in these populations are the availability of resources (time and money) and the maturity of the epidemic. When the epidemic is in the early stages and all areas of the country are not affected with the same intensity, people living in rural areas who lack the resources to travel are less likely to contract the infection. By contrast, people with greater wealth and those living in urban areas are more likely to come into contact with the virus and are better placed to engage in sexual relationships with multiple partners and unsafe sexual practices.
The association between poverty –or wealth– and HIV is context-specific
Once the epidemic has matured and spread to all parts of the country, the poorest populations in rural areas become the group most likely to be exposed to the virus. At the same time, as the population gains a better understanding of the disease, the more affluent groups tend to be the first to learn how to protect themselves against infection.
We cannot put all regions and communities in the same bag as they are all different: the epidemic has started at a different time and follows a different course in each one. Clearly, the association between poverty (or wealth) and HIV is context-specific and each community concerned about the course of the epidemic within its population needs to study its specific characteristics to determine the best way to counteract the epidemic and put an end to it.
Although the poorest people in the community are more likely to be infected by the virus, it cannot be said that HIV is a infection of the poor
It is for this reason that ISGlobal has studied the HIV epidemic in Manhiça, a district in southern Mozambique where we have been working for the past 20 years. Manhiça is a semi rural region close to the South African border with an incredibly high prevalence of HIV infection (40%). The study found that the poorest people in the community are more likely to be infected by the virus and these groups therefore require special attention. Nevertheless, the findings also show that the community needs to work with other, more affluent, social groups as well because these also have a very high prevalence of HIV. Consequently, it cannot be said that HIV is a infection of the poor even in a district like Manhiça where the poorest sectors of the population do have the highest levels of HIV infection.
Women had a higher probability of being HIV-positive than men at all wealth levels and ages
Our study also had certain innovative features, which add to the value of the analysis and the findings. First, we used a wealth index based on the characteristics and assets of each household, which were used as a proxy for the individual’s socioeconomic status. We used multiple correspondence analysis (MCA) to compute this index. This choice differentiates our study from others because MCA is a more appropriate tool for the type of data being analysed than the one most often used for this purpose (principal components analysis). Furthermore, the analysis was adjusted for age and sex and took into account the non-linear relationship between age and HIV infection. This allowed us to observe that the probability of being HIV positive in Manhiça increased up to 36 years of age and then decreased progressively. Women had a higher probability of being HIV-positive than men at all wealth levels and ages.
Such improvements in analytical methods and innovations in study design are essential if the scientific community is to gain a better understanding of important associations, such as the relationship between HIV and poverty or wealth. In this way, little by little, we can work towards their elimination.