A South African study reveals that among individuals of lower socioeconomic status, men are less likely than women to seek HIV testing, while women from similar backgrounds who engage in risky sexual behavior are at greater risk of HIV infection.
South Africa has one of the highest HIV rates in the world, affecting about 19.1% of the population. However, within the country, the HIV burden differs among population groups. HIV prevalence is exceptionally high in urban townships, low-income subdistricts initially designated for non-Whites.
Currently, most HIV prevention strategies focus on influencing behavior, knowledge, and attitudes. However, socioeconomic factors affect education, employment status, and income, and thus cause health inequalities. This study, published in PLOS Global Public Health, explored the role of socioeconomic status in HIV risk. It also looked at how socioeconomic factors influence certain sexual behaviors.
Low Socioeconomic Status is a Considerable Risk Factor for HIV Acquisition
This study used data from a quasi-randomized trial in Cape Town. The trial was conducted between January 1017 to June 2018. This study primarily aimed to evaluate HIVSmart!, a digital HIV self-testing program. Secondary analysis of the data from the study helped identify factors contributing to higher HIV risk and health inequalities.
The trial included data from 3095 individuals from 3 subdistricts, and it considered individual factors like testing history, HIV exposure, comorbidities, and tuberculosis infection. It also considered behavioral factors like unprotected sex with multiple partners, living with an HIV-positive partner, and drug and alcohol use. The study found a strong association between HIV risk, living in informal dwellings, and not having post-secondary education (aOR, 89% CrI: 1.34, 1.07–1.68 and 1.82, 1.29–2.61, respectively).
They found that individuals from lower socioeconomic status, especially men, were less likely to seek HIV testing. Women had increased HIV acquisition risk after controlling for all individual, behavioral, and socioeconomic factors. Female participants in the lowest income strata were less likely than men to have multiple sexual partners; however, females without post-secondary education were more likely to have sex with a partner living with HIV. The study also found that unmarried individuals were at a greater risk.
The researchers conclude that insights from this study are valuable in that, while most global studies focus on encouraging condom use, sexual education, HIV testing, and pre-exposure prophylaxis for HIV prevention, this study shows that socioeconomic factors significantly increase the risk of HIV acquisition. Without reducing socioeconomic disparities, HIV prevention would be challenging in many instances.
Limitations of the study include analyzing secondary data from sub-districts of Cape Town, which is not generalizable to other population groups. Moreover, such secondary data may be unsuitable for detecting HIV infection risk due to the homogeneous distribution of socioeconomic factors in the studied population.
The Bottom Line
To sum up, the study demonstrated that factors like unstable dwelling, lower education, and residing in subdistricts with low income promote specific behaviors and increase the risk of HIV acquisition. Socioeconomic factors affect males and females differently. Males were more likely to avoid HIV testing and females who engaged in sexual risk-taking were at greater risk of contracting HIV than their male counterparts. These results stress the importance of countering socioeconomic inequalities as part of a diverse HIV prevention strategy.
Source:
Soo, C. L., Pai, N. P., Bartlett, S. J., Esmail, A., Dheda, K., & Bhatnagar, S. (2023). Socioeconomic factors impact the risk of HIV acquisition in the township population of South Africa: A Bayesian analysis. PLOS Global Public Health, 3(1), e0001502. https://doi.org/10.1371/journal.pgph.0001502
