Socioeconomic Status as a Risk Factor for Hiv Infection in Women in East, Central and Southern Africa: A Systematic Review

Abstract

This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women's access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female's SES and fourteen also included a measurement of partner's SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income subSaharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita 1 income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner's SES (measured by education or income/ employment) may be a stronger predictor of female HIV serostatus than measures of female SES.

Poverty and HIV/AIDS in South Africa: an empirical contribution

“…These studies were selected on the basis of 'type of study design; representativeness of study sample of country or regional population; completeness of follow-up for cohort studies; measurement of SES and measurement of outcome indicators or other indicators of sexual risk-taking' (Wojcicki, 2005, pp.5-6). Fifteen of these studies found no association between SES and HIV infection; 12 found an association between low SES and HIV infection; and 1 yielded mixed results (Wojcicki, 2005).…”

“…That poverty and disease are inextricably linked is widely accepted, as is evident from the mounting literature on the subject (Barnett & Whiteside, 2002;Booysen, 2004;Wojcicki, 2005), as well as public debate on the issue (The Chatroom, SABC 1, 25 July 2004). Recent research has tended to extend this link to HIV/AIDS.…”

The case for expanding the definition of ‘key populations’ to include high-risk groups in the general population to improve targeted HIV prevention efforts

“…[13,14] Women globally, and black African women in particular, tend to fall into the lower socio economic stratum and are disproportionately affected by HIV. [15] There is also evidence that the association between HIV, SES and gender varies depending on income inequality in the general population.…”

“…Where income per capita is high and intracountry inequalities are high, HIV risk increases. [14] With regard to employment status, black women were more likely than black men to be unemployed and looking for work. Full-time employment rates were higher for men than for women.…”

Poverty, Parasitosis and HIV/AIDS - Major Health Concerns in Tanzania

“…This kind of despair and total lack of hope of improving wellbeing at household, drive this woman and several other into ''problem''. Contradictory evidences exist with regard to HIV vulnerability at the level of households and communities (Wojciki 2005;Giraldo, 1997). Early studies had demonstrated positive correlations between household economic resources, education, and HIV infection, as the epidemic progressed; however currently, this relationship is somehow slightly changing.…”