Abstract
BackgroundHuman immunodeficiency virus (HIV) is a significant contributor to Malawi's burden of disease. Despite a number of studies describing socio-economic differences in HIV prevalence, there is a paucity of evidence on socio-economic inequity in HIV testing in Malawi.ObjectiveTo assess horizontal inequity (HI) in HIV testing in Malawi.DesignData from the Demographic and Health Surveys (DHSs) 2004 and 2010 in Malawi are used for the analysis. The sample size for DHS 2004 was 14,571 (women =11,362 and men=3,209), and for DHS 2010 it was 29,830 (women=22,716 and men=7,114). The concentration index is used to quantify the amount of socio-economic-related inequality in HIV testing. The inequality is a primary method in this study. Corrected need, a further adjustment of the standard decomposition index, was calculated. Standard HI was compared with corrected need-adjusted inequity. Variables used to measure health need include symptoms of sexually transmitted infections. Non-need variables include wealth, education, literacy and marital status.ResultsBetween 2004 and 2010, the proportion of the population ever tested for HIV increased from 15 to 75% among women and from 16 to 54% among men. The need for HIV testing among men was concentrated among the relatively wealthy in 2004, but the need was more equitably distributed in 2010. Standard HI was 0.152 in 2004 and 0.008 in 2010 among women, and 0.186 in 2004 and 0.04 in 2010 among men. Rural–urban inequity also fell in this period, but HIV testing remained pro-rich among rural men (HI 0.041). The main social contributors to inequity in HIV testing were wealth in 2004 and education in 2010.ConclusionsInequity in HIV testing in Malawi decreased between 2004 and 2010. This may be due to the increased support to HIV testing by global donors over this period.
Highlights
IntroductionMalawi has a high-level human immunodeficiency virus (HIV) epidemic. An estimated 1,100,000 people, or approximately 11% of the total population, were living with HIV in 2012 [1]
Overall, Malawi has a high-level human immunodeficiency virus (HIV) epidemic
While the concentration index quantifies the extent of an inequality, or inequity, the decomposition method uses a regressionbased approach to explore the determinants of inequity, that is, the contribution of different health need and nonneed factors to the inequity identified in the concentration index
Summary
Malawi has a high-level human immunodeficiency virus (HIV) epidemic. An estimated 1,100,000 people, or approximately 11% of the total population, were living with HIV in 2012 [1]. In 2013, the Joint United Nations Programme on HIV/ AIDS (UNAIDS) set the ‘90Á90Á90 goals’ to mobilise the global response to HIV. According to these goals, by 2020, 90% of people living with HIV should be aware of their HIV status, 90% of those known to be HIV positive should be on treatment and 90% of people on treatment should be virally suppressed [3]. Despite a number of studies describing socio-economic differences in HIV prevalence, there is a paucity of evidence on socio-economic inequity in HIV testing in Malawi. Conclusions: Inequity in HIV testing in Malawi decreased between 2004 and 2010 This may be due to the increased support to HIV testing by global donors over this period
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