Economic Inequality as an Underlying Cause of HIV in Africa? The HIV-Poverty Thesis Re-Examined

Ashley M. Fox, Columbia University

Contrary to theories of poverty as the underlying cause of HIV in Africa, an increasing body of evidence at the national and individual levels indicates that wealthier countries and individuals within countries, are at heightened risk for HIV. This study tests the hypothesis that HIV infection increases under conditions of socioeconomic inequality rather than poverty. Examining demographic and health survey data from 16African countries, this study utilizes a multilevel model to assess the relationship between HIV infection and economic inequality. All multivariate models were run as a two-level, hierarchical random intercept and slope models in Stata adjusted for clustering at the regional level. Results from the two-level random intercept model demonstrated that individual wealth quintile and regional gini coefficient are positive and significant. As hypothesized, wealthier individuals are at higher risk for HIV infection and the probability of infection increases with rising regional (within-country) inequality.