Date Published: June 7, 2018
Author(s): Patrick Igulot, Monica A. Magadi.
There is controversy on the association between socioeconomic status (SES) and HIV infection. Some evidence claims higher SES is negatively associated with HIV infection while others report the reverse.
To examine the association between SES and HIV infection in Uganda and to examine whether the SES-HIV relationship varies by gender, rural-urban place of residence, and time (2004-2005 and 2011) in Uganda.
Multilevel analysis was applied to 39,766 individual cases obtained in 887 clusters of Uganda HIV/AIDS Indicators Survey conducted in 2004-2005 and 2011.
Household wealth is associated with increased vulnerability in the general population and in rural areas. Compared with no educational attainment, secondary or higher education is associated with reduced vulnerability to the risk of HIV infection by 37% in the general population. However, this effect was stronger in urban than rural areas. Besides individual-level factors, unobserved community factors too play an important role and account for 9% of unexplained variance after individual-level factors are considered.
Household wealth increases vulnerability but education reduces it. The social environment influences vulnerability to HIV infection independent of individual-level factors. HIV/AIDS awareness targeting sexual practices of wealthy individuals and those with primary-level educational attainment together with improving educational attainment and addressing contextual factors influencing vulnerability to HIV infection are necessary strategies to reduce HIV infections in Uganda.
The association between socioeconomic status (SES) and HIV infection in sub-Saharan Africa (SSA) is controversial. Considerable research attention has been given to the relationship between SES and HIV in SSA, a region that suffers a disproportionate higher burden of HIV/AIDS. Some studies suggest that people with low, while others suggest that those with high SES are more vulnerable to HIV infection [1–3]. More studies have demonstrated the positive relationship between SES and vulnerability to HIV infection in SSA [4–6]. Previous studies have used diverse measures of SES, including employment. However, in this paper, wealth and education are used as the main measures of SES because they are consistently defined and measured in the AIDS Indicator Survey (AIS).
In the multilevel modelling, four models were fitted, starting with wealth and education in the first model and then controlling for other characteristics. In the final model, evidence in Table 2 shows that there is a general positive association between wealth and HIV prevalence, with prevalence in the highest wealth households being 20% higher than in the lowest wealth quintile households after controlling for background characteristics. The higher HIV prevalence among those in the highest wealth quintile becomes evident when socioeconomic and demographic factors were controlled for in Model 3. However, this ceased to be significant in Model 4 when sexual behavior factors were controlled for, suggesting that the higher HIV vulnerability among wealthy individuals was partly explained by sexual behavior factors, which is consistent with existing literature.
This research set out to examine the association between SES and HIV infection in Uganda. This research found significant positive associations between household wealth status and HIV infection at the population level, in rural areas, and among women. However, higher educational attainment was negatively associated with being infected with HIV at the population level, among women and men, in urban areas, and in 2011. Overall, secondary or higher education was associated with reduced vulnerability to HIV infection by 37%, compared to no education.