DO THE FACTORS ASSOCIATED WITH FEMALE HIV INFECTION VARY BY SOCIOECONOMIC STATUS IN CAMEROON?

2013 ◽  
Vol 46 (4) ◽  
pp. 431-448 ◽  
Author(s):  
JOYCE N. MUMAH ◽  
DOUGLAS JACKSON-SMITH
Keyword(s):  
Hiv Infection ◽  
Hiv Risk ◽  
Access To Health Care ◽  
Social Epidemiology ◽  
Sub Saharan Africa ◽  
Low Ses ◽  
Factors Associated ◽  
Increased Risk ◽  
Sub Saharan ◽  
Using Data

SummaryOne of the most consistent findings in social epidemiology is an inverse relationship between indicators of SES and most types of illness. However, a growing body of research on HIV in sub-Saharan Africa suggests an intriguing reversal of this pattern, particularly with respect to HIV among women. In Cameroon, specifically, high-SES women have higher rates of HIV infection compared with low-SES women. Using data from the 2004 Cameroon DHS, this study explored the relationships between SES and HIV and tested a multivariate model designed to highlight the distinctive factors associated with increased risk of HIV among women in different SES classes. The results revealed that high-SES women who reported engaging in riskier sexual behaviour had the highest levels of HIV infection. Surprisingly, among this group increased knowledge of HIV, more domestic decision-making authority and access to health care did not reduce vulnerability. Meanwhile, among low-SES women relative gender inequality was significantly related to HIV risk. Specifically, among this group of women, having a partner with higher education was strongly associated with greater HIV risk. The results suggest that different approaches targeting each sub-group are needed to effectively combat the disease.

scholarly journals HIV prevalence and sexual behaviour at older ages in rural Malawi

2012 ◽  
Vol 23 (7) ◽  
pp. 490-496 ◽  
Author(s):  
E Freeman ◽  
P Anglewicz
Keyword(s):  
Hiv Infection ◽  
Hiv Risk ◽  
Sexual Behaviour ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Older Individuals ◽  
Number Of Sexual Partners ◽  
Sub Saharan ◽  
Using Data ◽  
Older Populations

Research on HIV infection and sexual behaviour in sub-Saharan Africa typically focuses on individuals aged 15–49 years under the assumption that both become less relevant for older individuals. We test this assumption using data from rural Malawi to compare sexual behaviour and HIV infection for individuals aged 15–49 with individuals aged 50–64 and 65 and over years. Although general declines with age were observed, levels of sexual activity and HIV remained considerable: 26.7% and 73.8% of women and men aged 65+ reported having sex in the last year, respectively; men's average number of sexual partners remained above one; and HIV prevalence is significantly higher for men aged 50–64 (8.9%) than men aged 15–49 (4.1 %). We conclude that older populations are relevant to studies of sexual behaviour and HIV risk. Their importance is likely to increase as access to antiretrovirals in Africa increases. We recommend inclusion of adults aged over 49 years in African HIV/AIDS research and prevention efforts.

SOCIOECONOMIC STATUS AS A RISK FACTOR FOR HIV INFECTION IN WOMEN IN EAST, CENTRAL AND SOUTHERN AFRICA: A SYSTEMATIC REVIEW

2004 ◽  
Vol 37 (1) ◽  
pp. 1-36 ◽  
Author(s):  
JANET MAIA WOJCICKI
Keyword(s):  
Systematic Review ◽  
Socioeconomic Status ◽  
Hiv Infection ◽  
Southern Africa ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Low Ses ◽  
Causal Pathway ◽  
Sub Saharan

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 sub-Saharan 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 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.

scholarly journals Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in a multi-country cohort study: US-PEPFAR PROMOTE study

2019 ◽  
Author(s):  
Patience Atuhaire ◽  
Sherika Hanley ◽  
Nonhlanhla Yende-Zuma ◽  
Jim Aizire ◽  
Lynda Stranix-Chibanda ◽  
...  
Keyword(s):  
Cohort Study ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
African Women ◽  
Targeted Interventions ◽  
Factors Associated ◽  
Women Living With Hiv ◽  
Increased Risk ◽  
Sub Saharan ◽  
Living With Hiv

AbstractBackgroundDespite recent efforts to scale-up lifelong combination antiretroviral therapy (cART) in sub-Saharan Africa, high rates of unsuppressed viremia persist among cART users, and many countries in the region fall short of the UNAIDS 2020 target to have 90% virally suppressed. We sought to determine the factors associated with unsuppressed viremia (defined for the purpose of this study as >200 copies/ml) among African women on lifelong cART.MethodsThis analysis was based on baseline data of the PROMOTE longitudinal cohort study at 8 sites in Uganda, Malawi, Zimbabwe and South Africa. The study enrolled 1987 women living with HIV who initiated lifelong cART at least 1 year previously to assesses long-term safety and effectiveness of cART. Socio-demographic, clinical, and cART adherence data were collected. We used multivariable Poisson regression with robust variance to identify factors associated with unsuppressed viremia.ResultsAt enrolment, 1947/1987 (98%) women reported taking cART. Of these, HIV-1 remained detectable in 293/1934 (15%), while 216/1934 (11.2%) were considered unsuppressed (>200 copies/ml). The following factors were associated with an increased risk of unsuppressed viremia: not having household electricity (adjusted prevalence rate ratio (aPRR) 1.74, 95% confidence interval (CI) 1.28-2.36, p<0.001); self-reported missed cART doses (aPRR 1.63, 95% CI 1.24-2.13, p<0.001); recent hospitalization (aPRR 2.48, 95% CI 1.28-4.80, p=0.007) and experiencing abnormal vaginal discharge in the last three months (aPRR 1.88; 95% CI 1.16-3.04, p=0.010). Longer time on cART (aPRR 0.75, 95% CI 0.64-0.88, p<0.001) and being older (aPRR 0.77, 95% CI 0.76-0.88, p<0.001) were associated with reduced risk of unsuppressed viremia.ConclusionSocioeconomic barriers such as poverty, not being married, young age, and self-reported missed doses remain key predictors of unsuppressed viremia. Targeted interventions are needed to improve cART adherence among women living with HIV with this risk factor profile.

scholarly journals Knowledge of blood-borne transmission risk is inversely associated with HIV infection in sub-Saharan Africa

2011 ◽  
Vol 5 (03) ◽  
pp. 182-198 ◽  
Author(s):  
Devon D. Brewer
Keyword(s):  
Public Education ◽  
Hiv Infection ◽  
Hiv Risk ◽  
Southern Africa ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Hiv Risks ◽  
Education Campaigns ◽  
Sub Saharan

Introduction: Accurate, comprehensive knowledge of an infectious pathogen's modes of transmission helps people to avoid infection. Growing evidence suggests that blood-borne HIV transmission is widespread in sub-Saharan Africa. Methodology: I examined the association between knowledge of blood-borne HIV risk and prevalent HIV infection in Demographic and Health Survey data from 16 sub-Saharan African countries. I also searched three online databases for evidence of public education campaigns focused on blood-borne HIV risks in these countries. Results: Knowledge was moderately to strongly inversely related to HIV prevalence at the national level (i.e., countries in which many respondents were aware of blood-borne risk had lower HIV prevalence than countries in which few respondents were aware of such risk). At the individual level, respondents who knew about blood-borne HIV risks were modestly less likely to be infected than those who did not show awareness of this risk, independent of demographic and sexual behavior variables. This relationship was stronger in southern Africa than in west, central, and east Africa. In parallel analyses, knowledge of condom use as a way to prevent HIV was positively associated with prevalent HIV infection at both the national and individual levels. West, central, and east African countries with low to moderate HIV prevalence had implemented public education campaigns that included a focus on blood-borne transmission risks. Such campaigns were absent from high prevalence countries in southern Africa. Conclusion: These findings suggest that knowledge of blood-borne HIV risk protects against HIV infection and that public education campaigns are important for spreading that knowledge. 

Incident gonorrhoea and chlamydia among a prospective cohort of men who have sex with men in Kisumu, Kenya

2020 ◽  
Vol 96 (7) ◽  
pp. 521-527 ◽  
Author(s):  
Fredrick Otieno ◽  
George Ng'ety ◽  
Duncan Okall ◽  
Carolyne Aketch ◽  
Eve Obondi ◽  
...  
Keyword(s):  
Cox Regression ◽  
Sub Saharan Africa ◽  
Repeated Testing ◽  
Factors Associated ◽  
Increased Risk ◽  
High Incidence ◽  
Hiv Testing And Counselling ◽  
Sub Saharan ◽  
Sex With Men ◽  
Adjusted Model

ObjectiveSTIs disproportionately affect men who have sex with men (MSM) in sub-Saharan Africa. We identified factors associated with incident Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among MSM in the Anza Mapema cohort study in Kisumu, Kenya.MethodsWe enrolled 711 MSM who underwent HIV testing and counselling, medical history and examination, and collection of demographic and behavioural information. They also provided urine and rectal swab specimens for CT and NG testing by qualitative PCR at baseline and at months 6 and 12. Separate multivariable Cox regression models identified factors associated with first incident urethral or rectal infection.ResultsAmong the 619 men aged 18–54 years included in this analysis, there were 83 first incident urethral CT/NG infections (14.4 cases per 100 person-years (PY)) and 40 first incident rectal infections (6.84 cases per 100 PY), and an overall incidence of 18.0 cases per 100 PY (95% CI 14.8 to 21.8). Most urethral (84%) and rectal (81%) infections were asymptomatic. In the adjusted model, the risk of first incident urethral CT/NG decreased by 4% for each 1-year increase in age and was 41% lower for men who reported their partner used condom at last sexual encounter. Men who were HIV-positive had a 68% less risk of urogenital CT/NG compared with those who were negative. Men who reported being usually receptive or versatile as compared with usually insertive had an 81% increased risk of incident urogenital CT/NG.ConclusionOur study demonstrated a high incidence of urethral CT/NG infection, with somewhat lower incidence of rectal CT/NG infection, despite repeated testing and treatment, highlighting the need for preventive interventions to decrease the burden of CT/NG among Kenyan MSM. Most infections were asymptomatic, and routine aetiological screening for STIs is recommended.

scholarly journals An update on alcohol use and risk of HIV infection in sub-Saharan Africa: Meta-analysis and future research directions

2013 ◽  
Vol 2 (1) ◽  
pp. 99-110 ◽  
Author(s):  
Sarah E Woolf-King ◽  
Craig M Steinmaus ◽  
Arthur L Reingold ◽  
Judith A Hahn
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Use ◽  
Hiv Infection ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Future Research ◽  
Research Directions ◽  
Increased Risk ◽  
Future Research Directions ◽  
Sub Saharan

Woolf-King, S., Steinmaus, C. M., Reingold, A. L. & Hahn, J. A. (2013). An update on alcohol use and risk of HIV infection in sub-Saharan Africa: Meta-analysis and future research directions. International Journal of Alcohol and Drug Research, 2(1), 99-110.  doi: 10.7895/ijadr.v2i1.45 (http://dx.doi.org/10.7895/ijadr.v2i1.45)Aims: Sub-Saharan Africa is disproportionately affected by HIV/AIDS, and growing evidence suggests that alcohol consumption is a co-occurring problem in the region.  We conducted a meta-analysis on studies of alcohol use and HIV infection in sub-Saharan Africa in order to assess associations, evaluate heterogeneity in the literature, identify susceptible subgroups, and suggest avenues for future research.Design: We performed a systematic review, including published review articles and electronic database searches, and identified 35 studies on alcohol use and HIV.Setting and participants: All of the studies included in the meta-analysis occurred with adults in sub-Saharan Africa.Measurements: Pooled odds ratio (OR) estimates were calculated using both the fixed inverse variance weighting method and the random effects method when evidence of heterogeneity was present.Findings: The pooled OR estimate for all studies was 1.61 (95% CI: 1.44–1.80).  The association between alcohol use and prevalence or incident HIV infection was particularly large among samples who reported problem drinking (OR = 2.17, 95% CI: 1.64–2.87) and drinking in sexual contexts (OR = 1.79, 95% CI: 1.55–2.06).  Some evidence of publication bias was present; however, the OR remained statistically significant in small and large studies and with population-based and high-risk samples.Conclusions: These results suggest that alcohol consumption, particularly at high levels and in sexual contexts, is associated with an increased risk of HIV infection.  An increased focus on methods that allow for more sensitive tests of the event-level association between alcohol consumption and risk of HIV infection may provide a better understanding of the causal mechanisms underlying this relationship.

scholarly journals Risk scores for predicting HIV incidence among the general population in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Katherine M. Jia ◽  
Hallie Eilerts ◽  
Olanrewaju Edun ◽  
Kevin Lam ◽  
Adam Howes ◽  
...  
Keyword(s):  
General Population ◽  
Hiv Infection ◽  
Hiv Risk ◽  
Meta Analysis ◽  
Random Effect ◽  
Community Level ◽  
Sub Saharan Africa ◽  
Risk Scores ◽  
Younger Age ◽  
Sub Saharan

AbstractIntroductionSeveral HIV ‘risk scores’ have been developed to identify individuals for prioritised HIV prevention in sub-Saharan Africa. We systematically reviewed HIV risk scores to: (i) identify factors that consistently predicted incident HIV infection, (ii) review inclusion of community-level HIV risk in predictive models, and (iii) examine predictive performance.MethodsWe systematically searched nine databases for studies developing and/or validating HIV risk scores among the general population in sub-Saharan Africa from database inception until February 15, 2021. Studies not prospectively observing seroconversion or recruiting only key populations were excluded. Record screening, data extraction, and critical appraisal were conducted in duplicate. We used random-effect meta-analysis to summarise hazard ratios and the area under the receiver-operating characteristic curve (AUC-ROC).ResultsFrom 1563 initial search records, we identified 14 risk scores in 13 studies. Seven studies were among sexually active women using contraception enrolled in randomised-controlled trials, three among adolescent girls and young women (AGYW), and three among cohorts enrolling both men and women. Consistently identified HIV prognostic factors among women were younger age (pooled adjusted hazard ratio: 1.62 [95% Confidence Interval: 1.17, 2.23], compared to above-25), single/not cohabiting with primary partners (2.33 [1.73, 3.13]) and having sexually transmitted infections (STIs) at baseline (HSV-2: 1.67 [1.34, 2.09]; curable STIs: 1.45 [1.17; 1.79]). Among AGYW only STIs were consistently associated with higher incidence, but studies were limited (n=3). Community-level HIV prevalence or unsuppressed viral load strongly predicted incidence but were only considered in three of 11 multi-site studies. The AUC-ROC ranged from 0.56 to 0.79 on the model development sets. Only the VOICE score was externally validated by multiple studies, with pooled AUC-ROC 0.626 [0.588, 0.663] (I2: 64.02%).ConclusionsYounger age, non-cohabiting, and recent STIs were consistently identified as predicting future HIV infection. Both community HIV burden and individual factors should be considered to quantify HIV risk. However, HIV risk scores had only low-to-moderate discriminatory ability and uncertain generalizability outside of the study populations. Further evidence on the relative value of specific factors and data outside high-risk populations will help inform optimal implementation of risk scoring algorithms in HIV programmes.PROSPERO NumberCRD42021236367

Interactions between ecological and socio-economic drivers of Buruli ulcer burden in Sub-Saharan Africa: opportunities for an improved control

2018 ◽  
Author(s):  
Andes Garchitorena ◽  
Matthew H. Bonds ◽  
Jean-Francois Guégan ◽  
Benjamin Roche
Keyword(s):  
Socioeconomic Factors ◽  
Disease Transmission ◽  
Access To Health Care ◽  
Buruli Ulcer ◽  
Mycobacterium Ulcerans ◽  
Sub Saharan Africa ◽  
Aquatic Environments ◽  
Human Populations ◽  
Complex Interactions ◽  
Sub Saharan

This chapter provides an overview of the complex interactions between ecological and socioeconomic factors for the development and control of Buruli ulcer in Sub-Saharan Africa. We review key ecological and evolutionary processes driving the environmental persistence and proliferation of Mycobacterium ulcerans, the causative agent, within aquatic environments, as well as transmission processes from these aquatic environments to human populations. We also outline key socioeconomic factors driving the economic and health burden of Buruli ulcer in endemic regions, revealed by reciprocal feedbacks between poverty, disease transmission from exposure aquatic environments and disease progression to severe stages owing to low access to health care. The implications of such insights for disease control, both in terms of limitations of current strategies and directions for the future, are discussed.

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