Abstract
Background 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. Objectives 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. Methods 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. Results 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. Conclusion 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.
Highlights
The association between socioeconomic status (SES) and HIV infection in sub-Saharan Africa (SSA) is controversial
In 2011, there was evidence of higher educational attainment beyond primary level being associated with reduced HIV prevalence for both males and females
The higher HIV prevalence among those in the highest wealth quintile becomes evident when socioeconomic and demographic factors were controlled for in Model 3. 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
Summary
The association between socioeconomic status (SES) and HIV infection in sub-Saharan Africa (SSA) is controversial. More studies have demonstrated the positive relationship between SES and vulnerability to HIV infection in SSA [4,5,6]. 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. This effect was stronger in urban than rural areas.
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