Epidemiology and Strategic Information Unit, Human Sciences Research Council, Private Bag X41, Pretoria 0001, Gauteng, South Africa.
BMC Public Health. 2013 Nov 4;13:1037. doi: 10.1186/1471-2458-13-1037.
The linkage between the socio-economic inequality and HIV outcomes was analysed using data from a population-based household survey that employed multistage-stratified sampling. The goal is to help refocus attention on how HIV is linked to inequalities.
A socio-economic index (SEI) score, derived using Multiple Correspondence Analysis of measures of ownership of durable assets, was used to generate three SEI groups: Low (poorest), Middle, and Upper (no so poor). Distribution of HIV outcomes (i.e. HIV prevalence, access to HIV/AIDS information, level of stigma towards HIV/AIDS, perceived HIV risk and sexual behaviour) across the SEI groups, and other background characteristics was assessed using weighted data. Univariate and multivariate logistic regression was used to assess the covariates of the HIV outcomes across the socio-economic groups. The study sample include 14,384 adults 15 years and older.
More women (57.5%) than men (42.3%) were found in the poor SEI [P<0.001]. HIV prevalence was highest among the poor (20.8%) followed by those in the middle (15.9%) and those in the upper SEI (4.6%) [P<0.001]. It was also highest among women compared to men (19.7% versus 11.4% respectively) and among black Africans (20.2%) compared to other races [P<0.001]. Individuals in the upper SEI reported higher frequency of HIV testing (59.3%) compared to the low SEI (47.7%) [P< 0.001]. Only 20.5% of those in poor SEI had "good access to HIV/AIDS information" compared to 79.5% in the upper SEI (P<0.001). A higher percentage of the poor had a stigmatizing attitude towards HIV/AIDS (45.6%) compared to those in the upper SEI (34.8%) [P< 0.001]. There was a high personal HIV risk perception among the poor (40.0%) and it declined significantly to 10.9% in the upper SEI.
Our findings underline the disproportionate burden of HIV disease and HIV fear among the poor and vulnerable in South Africa. The poor are further disadvantaged by lack of access to HIV information and HIV/AIDS services such as testing for HIV infection. There is a compelling urgency for the national HIV/AIDS response to maximizing program focus for the poor particularly women.
本研究利用基于人群的家庭调查数据，采用多阶段分层抽样方法，分析了社会经济不平等与艾滋病毒结局之间的关系。目的是帮助重新关注艾滋病毒与不平等之间的关系。
采用耐用资产拥有情况的多元对应分析，得出社会经济指数（SEI）评分，将其分为低（最贫困）、中、高（不太贫困）三组。使用加权数据评估 SEI 组间的艾滋病毒结局（即艾滋病毒流行率、艾滋病毒/艾滋病信息获取情况、对艾滋病毒/艾滋病的污名化程度、艾滋病毒风险感知和性行为）分布情况以及其他背景特征。使用单变量和多变量逻辑回归评估社会经济群体中艾滋病毒结局的协变量。研究样本包括 14384 名 15 岁及以上的成年人。
在贫困 SEI 组中，女性（57.5%）多于男性（42.3%）（P<0.001）。艾滋病毒流行率在贫困人群中最高（20.8%），其次是中等收入人群（15.9%）和高收入人群（4.6%）（P<0.001）。女性的艾滋病毒流行率也高于男性（分别为 19.7%和 11.4%），黑非洲人（20.2%）高于其他种族（P<0.001）。在高 SEI 组中，报告进行 HIV 检测的频率更高（59.3%），而在低 SEI 组中则为 47.7%（P<0.001）。只有 20.5%的贫困人群“能很好地获取艾滋病毒/艾滋病信息”，而高 SEI 组中有 79.5%（P<0.001）。贫困人群对艾滋病毒/艾滋病的污名化态度比例较高（45.6%），而高 SEI 组中这一比例为 34.8%（P<0.001）。贫困人群对个人感染艾滋病毒的风险感知较高（40.0%），而在高 SEI 组中这一比例显著下降至 10.9%。
本研究结果强调了南非贫困人口和弱势群体中艾滋病毒疾病和艾滋病毒恐惧的不成比例负担。由于缺乏获取艾滋病毒信息和艾滋病毒/艾滋病服务（如艾滋病毒感染检测），贫困人口进一步处于不利地位。国家艾滋病毒/艾滋病应对措施迫切需要将重点放在贫困人口，特别是妇女身上。
