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首页> 外文期刊>Journal of biosocial science >THE HIV-POVERTY THESIS RE-EXAMINED: POVERTY, WEALTH OR INEQUALITY AS A SOCIAL DETERMINANT OF HIV INFECTION IN SUB-SAHARAN AFRICA?
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THE HIV-POVERTY THESIS RE-EXAMINED: POVERTY, WEALTH OR INEQUALITY AS A SOCIAL DETERMINANT OF HIV INFECTION IN SUB-SAHARAN AFRICA?

机译：重新审视了艾滋病毒/艾滋病问题：贫穷，财富或不平等是撒哈拉以南非洲艾滋病毒感染的社会决定因素？

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摘要

Although health is generally believed to improve with higher wealth, research on HIV in sub-Saharan Africa has shown otherwise. Whereas researchers and advocates have frequently advanced poverty as a social determinant that can help to explain sub-Saharan Africa's disproportionate burden of HIV infection, recent evidence from population surveys suggests that HIV infection is higher among wealthier individuals. Furthermore, wealthier countries in Africa have experienced the fastest growing epidemics. Some researchers have theorized that inequality in wealth may be more important than absolute wealth in explaining why some countries have higher rates of infection and rapidly increasing epidemics. Studies taking a longitudinal approach have further suggested a dynamic process whereby wealth initially increases risk for HIV acquisition and later becomes protective. Prior studies, conducted exclusively at either the individual or the country level, have neither attempted to disentangle the effects of absolute and relative wealth on HIV infection nor to look simultaneously at different levels of analysis within countries at different stages in their epidemics. The current study used micro-, meso- and macro-level data from Demographic and Health Surveys (DHS) across 170 regions within sixteen countries in sub-Saharan Africa to test the hypothesis that socio-economic inequality, adjusted for absolute wealth, is associated with greater risk of HIV infection. These analyses reveal that inequality trumps wealth: living in a region with greater inequality in wealth was significantly associated with increased individual risk of HIV infection, net of absolute wealth. The findings also reveal a paradox that supports a dynamic interpretation of epidemic trends: in wealthier regions/countries, individuals with less wealth were more likely to be infected with HIV, whereas in poorer regions/countries, individuals with more wealth were more likely to be infected with HIV. These findings add additional nuance to existing literature on the relationship between HIV and socioeconomic status.
机译：尽管人们普遍相信，随着财富的增加，健康状况会改善，但对撒哈拉以南非洲地区艾滋病毒的研究却相反。尽管研究人员和倡导者经常将贫困作为一种社会决定因素，这可以帮助解释撒哈拉以南非洲的艾滋病毒感染负担过重，但最近的人口调查证据表明，较富裕的人群艾滋病毒感染率更高。此外，非洲较富裕国家的流行病增长最快。一些研究人员认为，在解释为什么某些国家的感染率更高和流行迅速增加的情况下，财富不平等可能比绝对财富更为重要。采取纵向方法的研究进一步提出了一个动态过程，在此过程中，财富最初增加了感染艾滋病毒的风险，后来变成保护性资产。以前仅在个人或国家一级进行的研究既没有试图消除绝对和相对财富对艾滋病毒感染的影响，也没有试图同时考察国家处于不同流行阶段的不同分析水平。本研究使用了来自撒哈拉以南非洲16个国家/地区170个地区的人口与健康调查（DHS）的微观，中观和宏观数据，检验了以下假设：经绝对财富调整后的社会经济不平等与社会经济不平等相关感染艾滋病毒的风险更大。这些分析表明，不平等胜过财富：生活在财富不平等程度更高的地区与个人感染艾滋病毒的绝对风险净增加的风险显着相关。研究结果还揭示了一个悖论，支持对流行趋势的动态解释：在较富裕的地区/国家中，财富较少的人更有可能感染艾滋病毒，而在较贫困的地区/国家中，财富较多的人则更有可能感染艾滋病毒。感染了艾滋病毒。这些发现为有关艾滋病毒与社会经济地位之间关系的现有文献增添了细微差别。

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  • 来源
    《Journal of biosocial science》 |2012年第4期|459-480|共22页
  • 作者

    ASHLEY M. FOX;

  • 作者单位

    Yale School of Public Health, Division of Health Policy and Administration, Yale University, USA;

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