Abstract
BackgroundDespite evidence of a positive SES-HIV gradient in some SSA countries, researchers and policy-makers frequently assume that a range of protective interventions – increasing awareness of mechanisms of HIV transmission, techniques for prevention, greater access to health care facilities, and greater availability of condoms – will reduce the likelihood of contracting HIV, even among higher SES populations. We therefore explore the relationships between SES and these intervening behaviors to illuminate the complex factors that link SES and HIV among women in Cameroon.MethodsWe use bivariate and multivariate statistical analysis to examine patterns among the 5, 155 women aged 15–49 who participated in the 2004 CDHS.ResultsThe results show a strong pattern where higher SES women have greater access to and use of health care facilities, higher levels of condom use, more HIV knowledge, and command higher power within their relationships, yet also have higher rates of HIV. These traditionally protective factors appear to be offset by riskier sexual behaviors on the part of women with increased resources, most notably longer years of premarital sexual experience, multiple partners in last 12 months, and sexual encounters outside of relationship. Multivariate analyses suggests net of the effect of other factors, women who command higher decision-making power, have greater access to health care, more negative attitudes toward wife beating, longer years of premarital sexual exposure, and partners with professional/white collar jobs (characteristics associated with rising SES) had higher odds of testing positive for HIV.ConclusionResults show that higher riskier sexual practices on part of high SES women offset benefits that may have accrued from their increased access to resources. The results suggest that traditional approaches to HIV prevention which rely on poverty reduction, improving access to health care, improving HIV knowledge, and boosting women’s social and economic power may be insufficient to address other drivers of HIV infection among women in SSA.
Highlights
Despite evidence of a positive socioeconomic status (SES)-HIV gradient in some SSA countries, researchers and policy-makers frequently assume that a range of protective interventions – increasing awareness of mechanisms of HIV transmission, techniques for prevention, greater access to health care facilities, and greater availability of condoms – will reduce the likelihood of contracting HIV, even among higher SES populations
A growing number of studies show that wealthier individuals, wealthier regions, and wealthier countries within SSA often display the highest levels of HIV infection [5,6,7,8,9,10,11,12,13,14,15]
The results clearly show that household wealth, educational attainment, and occupational status are significantly and positively related to HIV status among women in Cameroon
Summary
Despite evidence of a positive SES-HIV gradient in some SSA countries, researchers and policy-makers frequently assume that a range of protective interventions – increasing awareness of mechanisms of HIV transmission, techniques for prevention, greater access to health care facilities, and greater availability of condoms – will reduce the likelihood of contracting HIV, even among higher SES populations. It has often been assumed that Africa’s status as the continent with the highest HIV infection rates is linked to its endemic high poverty and a corresponding lack of access to adequate health care resources [2]. In SSA, high SES individuals have higher levels of formal education, greater exposure to health education messages and mass media, increased access to health care, and better access to condoms, which should all lower their risk for contracting HIV [4]. Kongnyuy and colleagues [17], found that wealthy men in Cameroon had higher rates of HIV infection, which in part was explained by their riskier sexual behaviors including earlier sexual debut, multiple concurrent and lifetime partners, and limited use of condoms with partners other than wives or cohabiting partners
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