Abstract #160  -  Understanding HIV in Southern Africa
Authors:   Presenting Author:   Prof. Larry Sawers - American University
Additional Authors:  Prof. Larry Sawers, Dr. Eileen Stillwaggon,
Aim: Adult HIV prevalence in the nine countries of southern Africa is over 15 times the prevalence in other low- and middle-income countries. Previous studies argue that the intensity of the HIV epidemic in southern Africa results from regional characteristics, such as apartheid labour regulations and mineral wealth, which contributed to circular migration patterns and highly skewed income distribution, both thought to promote risky sexual behaviour. The present study emphasizes the importance of cofactor diseases, which increase the likelihood of HIV transmission by increasing HIV viral load in infected persons and by making uninfected persons more vulnerable to HIV infection through genital lesions and/or inflammation.
Method / Issue: The study uses multiple regression analysis on country-level data with HIV prevalence as the dependent variable. Regressors include socio-economic and biomedical variables used in previous cross-national analyses of HIV to which we add a measure of cross-border migration and six cofactor infections.
Results / Comments: The socio-economic and biomedical variables explain statistically only 26 percent of the difference in HIV prevalence between southern Africa and other low- and middle-income countries. Adding the cofactor infection variables to the model allows us to explain statistically 70 percent of the southern Africa difference in HIV prevalence.
Discussion: The relative affluence of southern Africa and historical migration patterns have tended to mask the vulnerability of the majority of the population who are poor, and who have very high prevalence of infectious and parasitic diseases. Those diseases replicate a cycle of poverty that produces not just social vulnerability to HIV through risky behaviours but also biological vulnerability through coinfections. An important implication of this research is that integrating treatment of endemic diseases with other HIV-prevention policies may be necessary to slow the spread of HIV. Treatment of cofactor infections is a low-cost, policy-sensitive, high-impact variable.
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