Marseille 2007
| Abstract #268 - Factors contributing to differences in HIV/AIDS prevalence between South Africa and Bangladesh | ||||
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Session: 50.3: Transmission and social epidemiology (Parallel) on Wednesday @ 08.30-10.30 in PR Chaired by Brenda Spencer, Helene Sylvain Authors: Presenting Author: Prof Jeroen van Ginneken - NIDI, Netherlands |
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| Additional Authors: | ||||
| Aim: Leading politicians in South Africa (SA) have stated that poverty is the single most important underlying cause of the HIV epidemic in that country. We want to find out to what extent this is true and in particular how relevant poverty is in comparison with other factors. Our assumption is namely that it is a constellation of factors that together determine the seriousness of HIV/AIDS epidimics. In order to find out we will compare the situation in SA with an entirely different country namely Bangladesh. | ||||
| Method / Issue: The model of Barnett and Whiteside is used focusing on economic and social causes of HIV infection (heterosexual transmission), but we have made some mofications. Our model uses several groups of determinants, i.e., Biomedical, Sexual Behaviour, Family and Household Environment, Community Environment and Macro Economic and Political Environment. Several variables in each of the groups are selected and we want to find out to what extent scores on these variables differ between SA and Bangladesh. The emphasis is on presentation of quantitative evidence (through re-analysis of existing surveys, registration systems), but we also bring in qualitative evidence when it cannot be avoided. | ||||
| Results / Comments: Comparison of survey results at level of Biomedical and Sexual Behaviour shows, e.g., that prevalence fo other STDs is higher in SA than in B'desh, prev. of male circumcision is lower in SA than in B'desh, perc. of non-regular partners is higher in SA than in B'desh, level of use of condoms is low both in SA and in B'desh (all comparisons specified by sex and controlled by age). Comparison of data from surveys and registration systems shows at level of Family and Household Env. that e.g., perc. of all men and women that are married (incl stable unions) is lower in SA than in B'desh (controlled by age). At level of Macro Econ and Pol Env we find e.g., that per capita GDP is higher in SA than in B'desh and this also holds for per capita income in both the highest and lowest quintiles. Qualitative evidence helps to explain some of the findings presented above (at level of Family and Househ. Env). The amount of time that partners in marriages (incl stable unions) stay together in the course of marriages is lower in SA than in B'desh (more physical separation of spouses in SA). There is less social control on the lives of partners by the extended family in SA than in B'desh (e.g. arranged marriages and purdah system in B'desh)and this means less cohesion of partners in marriages in SA. Compariosn of high-risk behaviour in high-income groups in SA and B'desh shows a higher prevalence of this behaviour in SA than in B'desh. The high income of this group in SA helps to explain this high-risk behaviour. | ||||
| Discussion: A variety of factors together explain why the HIV/AIDS epidemic has become so severe in SA in comparison with B'desh. We studied only a number of them and they show, e.g., a higher prevalence of high-risk sexual behaviour in SA than in B'desh. Many factors help to explain why there is this difference. Qualitative evidence shows that in particular differences in family cohesion (both on average and in higher income groups) between SA and B'desh are important. Poverty is certainly an important factor leading to less stable and cohesive families in low-income groups in SA than in B'desh. It is one of the factors that influences high-risk behaviour of low-income families in SA. High income in the high-income families and other factors are in SA also important factors with an impact on the HIV epidemic. | ||||
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