Correlates of National HIV Seroprevalence: An Ecologic Analysis
Correlates of National HIV Seroprevalence: An Ecologic Analysis
Background: Ecologic analyses of social and developmental correlates of country-level HIV seroprevalence may suggest strategies for combating the HIV/AIDS epidemic.
Methods: Regression analyses were performed for 81 variables obtained primarily from United Nation agencies for 122 developing countries. Variable measures were compared between highest and lowest tertiles of HIV seroprevalence.
Results: Geography, religion, and income inequality were independently associated with HIV seroprevalence. Countries with earlier ages at first sex, higher teenage birth rates, and higher fertility rates had higher HIV seroprevalence. Countries with high HIV seroprevalence had fewer women using contraceptives, more persons with casual sex partners, and higher herpes simplex virus 2 seroprevalence. Male circumcision and Muslim religion were colinearly associated with lower HIV seroprevalence. Countries with high HIV seroprevalence had fewer doctors, more midwives, and less access to essential medications, but health spending differences were minor.
Conclusions: Ecologic analyses support population-level behavioral approaches, such as delaying sexual debut and discouraging casual sex partners, and reinforce biologic measures, such as controlling sexually transmitted infections and promoting male circumcision, for HIV prevention. Fewer births attended by skilled personnel, but more midwives, in countries with the highest HIV seroprevalence suggest potential strategies for reducing mother-to-child transmission. Correlations with selected health indicators suggest additional obstacles for implementing HIV treatment programs.
In 2000, HIV infection/AIDS caused >5% of all deaths world-wide, as the world's fourth leading cause of mortality, and became the leading cause of lost disability-adjusted life years for females. Although HIV infection/AIDS was the leading cause of mortality in sub-Saharan Africa, in some other world regions, HIV infection /AIDS failed to appear within the top 15 causes of mortality. In many developed countries, rates of HIV infection have decreased in association with programs that target reduction in risky sexual behaviors and sexually transmitted infection morbidity and provide widespread access to voluntary counseling and testing, prophylaxis for and treatment of HIV-related opportunistic infections, and, recently, multidrug antiretroviral therapy. However, in most developing countries, access to HIV prevention and treatment programs has been extremely limited, contributing to disparities between developed and developing countries in seroprevalence and mortality rates of HIV infection. Analyses of socioeconomic and developmental correlates of country-specific HIV seroprevalence might increase our understanding of the influence of societal characteristics on HIV transmission, reinforce individual-level studies, and suggest potential population-level interventions.
Background: Ecologic analyses of social and developmental correlates of country-level HIV seroprevalence may suggest strategies for combating the HIV/AIDS epidemic.
Methods: Regression analyses were performed for 81 variables obtained primarily from United Nation agencies for 122 developing countries. Variable measures were compared between highest and lowest tertiles of HIV seroprevalence.
Results: Geography, religion, and income inequality were independently associated with HIV seroprevalence. Countries with earlier ages at first sex, higher teenage birth rates, and higher fertility rates had higher HIV seroprevalence. Countries with high HIV seroprevalence had fewer women using contraceptives, more persons with casual sex partners, and higher herpes simplex virus 2 seroprevalence. Male circumcision and Muslim religion were colinearly associated with lower HIV seroprevalence. Countries with high HIV seroprevalence had fewer doctors, more midwives, and less access to essential medications, but health spending differences were minor.
Conclusions: Ecologic analyses support population-level behavioral approaches, such as delaying sexual debut and discouraging casual sex partners, and reinforce biologic measures, such as controlling sexually transmitted infections and promoting male circumcision, for HIV prevention. Fewer births attended by skilled personnel, but more midwives, in countries with the highest HIV seroprevalence suggest potential strategies for reducing mother-to-child transmission. Correlations with selected health indicators suggest additional obstacles for implementing HIV treatment programs.
In 2000, HIV infection/AIDS caused >5% of all deaths world-wide, as the world's fourth leading cause of mortality, and became the leading cause of lost disability-adjusted life years for females. Although HIV infection/AIDS was the leading cause of mortality in sub-Saharan Africa, in some other world regions, HIV infection /AIDS failed to appear within the top 15 causes of mortality. In many developed countries, rates of HIV infection have decreased in association with programs that target reduction in risky sexual behaviors and sexually transmitted infection morbidity and provide widespread access to voluntary counseling and testing, prophylaxis for and treatment of HIV-related opportunistic infections, and, recently, multidrug antiretroviral therapy. However, in most developing countries, access to HIV prevention and treatment programs has been extremely limited, contributing to disparities between developed and developing countries in seroprevalence and mortality rates of HIV infection. Analyses of socioeconomic and developmental correlates of country-specific HIV seroprevalence might increase our understanding of the influence of societal characteristics on HIV transmission, reinforce individual-level studies, and suggest potential population-level interventions.