BACKGROUND:Wealthier populations do better than poorer ones on most measures of health status, including nutrition, morbidity and mortality, and healthcare utilization. OBJECTIVES:This study examines the association between household wealth status and HIV serostatus to identify what characteristics and behaviours are associated with HIV infection, and the role of confounding factors such as place of residence and other risk factors. METHODS:Data are from eight national surveys in sub-Saharan Africa (Kenya, Ghana, Burkina Faso, Cameroon, Tanzania, Lesotho, Malawi, and Uganda) conducted during 2003-2005. Dried blood spot samples were collected and tested for HIV, following internationally accepted ethical standards and laboratory procedures. The association between household wealth (measured by an index based on household ownership of durable assets and other amenities) and HIV serostatus is examined using both descriptive and multivariate statistical methods. RESULTS:In all eight countries, adults in the wealthiest quintiles have a higher prevalence of HIV than those in the poorer quintiles. Prevalence increases monotonically with wealth in most cases. Similarly for cohabiting couples, the likelihood that one or both partners is HIV infected increases with wealth. The positive association between wealth and HIV prevalence is only partly explained by an association of wealth with other underlying factors, such as place of residence and education, and by differences in sexual behaviour, such as multiple sex partners, condom use, and male circumcision. CONCLUSION:In sub-Saharan Africa, HIV prevalence does not exhibit the same pattern of association with poverty as most other diseases. HIV programmes should also focus on the wealthier segments of the population.

译文

背景:在大多数健康状况指标(包括营养,发病率和死亡率以及医疗保健利用率)上,富裕人群的表现要比贫困人群好。
目的:本研究检查了家庭财富状况与艾滋病毒血清状况之间的关联,以识别与艾滋病毒感染相关的特征和行为,以及混杂因素(例如居住地和其他危险因素)的作用。
方法:数据来自2003-2005年在撒哈拉以南非洲(肯尼亚,加纳,布基纳法索,喀麦隆,坦桑尼亚,莱索托,马拉维和乌干达)进行的八次国家调查。按照国际公认的道德标准和实验室程序,收集干血斑样品并进行HIV检测。使用描述性统计方法和多元统计方法检查家庭财富(通过基于耐用资产和其他设施的家庭所有权的指数来衡量)与HIV血清状况之间的关联。
结果:在所有八个国家中,最富裕的五分之一成年人的艾滋病毒感染率高于较贫穷的五分之一成年人。在大多数情况下,患病率随财富单调增加。同样,对于同居伴侣,一个或两个伴侣感染艾滋病毒的可能性也会随着财富的增加而增加。财富与艾滋病毒感染率之间的正相关只能部分地通过财富与其他潜在因素(例如居住地和教育程度)的关联以及性行为的差异(例如,多性伴侣,使用避孕套和男性割礼)来解释。
结论:在撒哈拉以南非洲,艾滋病毒流行率与大多数其他疾病相比,没有表现出与贫困的关联。艾滋病毒规划也应侧重于较富裕的人群。

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