Cofactor infections and HIV epidemics in developing countries: implications for treatment

Abstract

This article shows that the burden of certain tropical disease infections, after controlling for other factors, is positively correlated with HIV prevalence. Using cross-national data and multivariate linear regression analysis, we investigate the determinants of HIV prevalence in low-and middle-income countries. We begin with social and economic variables used in other crossnational studies and then incorporate data on parasitic and infectious diseases endemic in poor populations, which are found to be strongly and significantly correlated with-and are potent predictors of-HIV prevalence. The paper concludes by arguing that treating tropical diseases may be a cost-effective addon to HIV prevention and treatment programs, thus slowing the spread of HIV in disease-burdened populations. AbstractThis article shows that the burden of certain tropical disease infections, after controlling for other factors, is positively correlated with HIV prevalence. Using cross-national data and multivariate linear regression analysis, we investigate the determinants of HIV prevalence in low-and middle-income countries. We begin with social and economic variables used in other cross-national studies and then incorporate data on parasitic and infectious diseases endemic in poor populations, which are found to be strongly and significantly correlated with-and are potent predictors of-HIV prevalence. The paper concludes by arguing that treating tropical diseases may be a cost-effective add-on to HIV prevention and treatment programs, thus slowing the spread of HIV in disease-burdened populations.

Community-Level Income Inequality and HIV Prevalence among Persons Who Inject Drugs in Thai Nguyen, Vietnam

“…The positive relationship between HIV prevalence and income inequality has been shown in a number of other studies in which the country was the unit of aggregation [13], [14], [16], [18], [19], [31]. In those studies, similar to our results, income inequality was also associated with HIV prevalence, and was not associated with absolute income on a per-capita (mean) basis.…”

“…Given results of cross-country studies [15], [16], [17], [18], [19], we hypothesize that we will also see higher HIV prevalence among PWID in communities with higher income inequality.…”

“…More recently, studies have found that HIV prevalence is more strongly associated with income inequality rather than with absolute level of income [15], [16], [17], [18], [19]. Most studies on income inequality and HIV prevalence to date have focused on generalized epidemics, primarily in sub-Saharan Africa, where the unit of analysis was a country.…”

Poverty, Sex and HIV

“…Bentwich et al 2000;Clerici et al 2001;Borkow and Bentwich 2006;Fauci 2007;Sawers et al 2008). But, while this points to the possible benefits of addressing co-infections, it is insufficient evidence to claim the primacy of poverty-related biological pathways in driving the HIV epidemic.…”

“…Caldwell 2002;Iliffe 2006). The dummy variables are probably also picking up the high prevalence of herpes simplex virus 2 (HSV-2) in Africa which is a known to heighten risk of HIV infection (Freeman et al 2006, Kapiga et al 2007Corey 2007;Drain et al 2004;Sawers et al 2008) and has argued to be a key driver of the HIV epidemic in Africa (Smith and Robinson 2002;Oster 2005;Abu-Raddad et al 2008). However, as the available data on HSV-2 varies greatly by coverage and year of assessment (Smith and Robinson 2002), it was not included here.…”