Poverty and HIV in sub-Saharan Africa

Abstract

International Development agencies and donors are increasingly adopting aid programmes directed towards poverty alleviation in sub-Saharan Africa. One of the goals of this policy is to reduce the prevalence of HIV. Colin Butler (Oct 21, p 1445)1Butler C HIV and AIDS, poverty, and causation.Lancet. 2000; 356: 1445-1446Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar concludes that povety is a major underlying causal factor for the scale of the African AIDS epidemic, but the relation between HIV and poverty is complex and there is little evidence that poverty-reduction policies are likely to succeed. HIV prevalence and gross national product (GNP) vary substantially between countries throughout sub-Saharan Africa. To investigate the relation between HIV and GNP in the region, we gathered data for HIV antenatal prevalences in the capital or major city, obtained by accessing the US Bureau of the census website (www.census.gov/ipc/www/hiv1.html, accessed on 15 Jan, 2001). For GNP, data were obtained from the World Bank website org (www.worldbank.org/data/countrydata/adi/adi1-1.pdf, accessed on 15 Jan, 2001), which reports the GNP for 1998. Data for HIV prevalencies (range 0–43%) and GNP (range US$140–3600) were available from these sources for 40 countries. The years in which HIV prevalence studies were done were 1998–99 (21), 1996–97 (16), and 1993–94 (3). Data for both variables were not available for Cape Verde, Djibouli, Liberia, Niger, Sao Tome, Seychelles, Sierra Leone, and Somalia. A scatter plot of HIV prevalence in antinatal-clinic attenders and GNP is shown in the figure. There is a weak positive correlation between HIV prevalence and GNP (Pearson correlation coefficient 0·29, p=0·07). This correlation is due to a few countries with high HIV prevalence and high GNP. The correlation disappears when the analysis is restricted to countries with GNPs lower than $1000 (n=32, Pearson correlation coefficient 0·04, =0·2). These results show that there is no correlation between a low GNP and a high HIV antenatal HIV prevalence. In two of the countries with the largest GNP—Botswana and South Africa—two of the highest HIV prevalences, 43%, and 32·5% respectively, are reported. Although there may be reasons at the individual level that predispose the poor to HIV, interventions to raise GNP at the macro level might not reduce new HIV transmissions. Clearly, we must continue to seek to implement HIV prevention interventions that target people at highest risk of HIV as early as possible in the epidemic. Alleviation of poverty alone, however politically acceptable and justifiable, will divert attention away from biological risk factors such as male circumcision status and poor genital hygiene in core groups that may be the determining influences that drive high-prevalence HIV epidemics.2O'Farrell N Enhanced efficiency of female to male HIV transmission in core groups in developing countries: the need to target men.Sex Transm Dis. 2001; 28: 84-91Crossref PubMed Scopus (34) Google Scholar