Does the ‘inverse equity hypothesis’ explain how both poverty and wealth can be associated with HIV prevalence in sub-Saharan Africa?

摘要: Whether it is relative wealth or poverty that drives the HIV epidemic in sub-Saharan Africa, a controversial aspect of HIV/AIDS epidemiology. We suggest social epidemiology Africa changing. Previously, new infections were more rapidly acquired by those relatively higher socioeconomic position (SEP). More recently, low SEP are at greater risk. If confirmed, we further this paper pattern would be compatible with Cesar Victora's ‘inverse equity hypothesis’, first articulated relation to child morbidity and mortality. The hypothesis suggests benefit from health interventions.1 Reviews draw different conclusions about association between infection within African countries. Some authors stress key driver HIV, alleviation only sustainable solution.2 Others show education associated risk, making unusual respect.3 A 2010 study contextual factors key, ‘being poor being wealthy may sets behaviours either protective risky for infection’.4 There might several methodological reasons diversity rates noted studies. First, range populations have been studied. studies analysed data unlinked anonymous testing samples collected among antenatal clinic attendees, while others recruited participants household surveys general population. Both types can suffer biases affecting reported HIV.5–7 Second, sampling frames vary. recruit small geographic areas sampled nationally. Heterogeneity will …