Area-Level Influences on Individual HIV Status in Rural Malawi

Caryl Feldacker, University of North Carolina at Chapel Hill

Few studies use spatial methods to explore relationships between people and place in Sub-Saharan Africa or in the context of HIV. This research uses individual-level data linked to area-level, spatially-oriented socioeconomic and access data to determine how the relationship between area- and individual-level risks and individual HIV status varies in rural Malawians using geographically weighted regression. The Political Economy of Health aids interpretation. Area-level factors include income inequality, absolute poverty and access to roads, cities and health clinics. Individual-level factors include high-risk sex and sexually transmitted infections. Stratified analysis reveals the role of gender. Spatial models show significant, local-level variation and indicate that area-level factors drive HIV patterns above individual-level contributions. In distinct locations, women who live further from health clinics, major roads and cities are less likely to be infected. For men, HIV is associated with migration patterns in specific areas. Local-level, gender-specific approaches to HIV prevention are necessary.