HIV/AIDS knowledge, women's education, epidemic severity and protective sexual behaviour in low- and middle-income countries

A fundamental public health strategy to reduce the risk of HIV/AIDS is to increase levels of awareness and knowledge about the disease. Although knowledge about HIV/AIDS and protective sexual behaviour are linked theoretically, relatively little is known about their empirical relationship. Using Demographic and Health Survey data from 23 low- and middle-income countries, this study used multilevel logistic regression models: to examine cross-national variability in the relationship between HIV/AIDS knowledge and protective behaviour (condom use and restricted sex); to investigate the moderating influences of women's educational attainment on this relationship; and to test the extent to which severity of the HIV/AIDS epidemic accounts for cross-national variability in the association between HIV/AIDS knowledge and protective behaviour. There was an association between increased knowledge of HIV/AIDS and condom use that varied in strength and form cross-nationally. This cross-national variation was accounted for partially by the socioeconomic characteristics of women resident in the study countries and between-country differences in the severity of the HIV epidemic. While education modified the association between HIV/AIDS knowledge and protective behaviour--stronger associations at lower levels of education--epidemic severity exerted a stronger influence on behaviour than any other characteristic. Finally, this study indicates that protective sexual practices are disturbingly low. In eight of 23 countries, overall levels of condom use to prevent STDs and HIV/AIDS were less than 5.0%. Waiting for the spread of HIV/AIDS infection to change sexual practices in low- and middle-income countries will result in dramatic unnecessary suffering.     

Attitudes and sexual behaviours of unmarried people with HIV/AIDS living in the Niger Delta region of Nigeria

Background Increasing morbidity and mortality associated with HIV/AIDS may be attributable to the lifestyle of individuals. Appropriate sexual behaviour and lifestyle modification may be helpful strategies for prevention and control of HIV/AIDS in many countries.Aim The study was designed to assess the impact of attitudes and sexual behaviour on control of HIV/AIDS among unmarried people living with HIV/AIDS in Uyo, a community in the Niger Delta region of Nigeria.Method A total of 365 unmarried individuals living with HIV/AIDS were assessed at the HIV clinic of the University of Uyo Teaching Hospital. Attitudes and sexual behaviour were evaluated using the Attitude and Sexual Behaviour Questionnaire adapted from previous studies.Results Of the 365 individuals living with HIV/AIDS, 142 (38.9%) were male and 223 (61.1%) were female. The majority of the subjects were below 50 years of age. The mean ages (± SD) of men and women were 36.8 ± 3.9 and 29.2 ± 1.7 years, respectively. Sexual attitudes and behaviours were variable. There was no change in the partner''s reaction to sex for 28.9% of men and 27.8% of women, abstinence in 7.7% of men and 8.1% of women, and breakdown of the relationship with the partner for 4.9% of men and 7.2% of women. More women than men agreed to undergo testing after their partners had tested positive for HIV. Sexual activity was higher in women than men, with 4.9% of men and 10.3% of women reporting daily sexual intercourse, 16.2% of men and 15.7% of women reporting weekly intercourse, and occasional sexual intercourse being reported by 44.4% of both men and women. After testing positive, 58.4% of male partners and 56.9% of female partners were persuaded to use condoms during sexual intercourse.Conclusion This study has demonstrated unhealthy attitudes and sexual behaviour among individuals living with HIV/AIDS in the Niger Delta region of Nigeria. This can potentially limit efforts and investment in controlling HIV/AIDS in this region. Therefore there is a need to initiate concrete policies and programmes that would encourage people living with HIV/AIDS in the Niger Delta region to adopt a healthy lifestyle.     

University students' knowledge of, and attitudes towards, hiv and AIDS, homosexuality and sexual risk behaviour: a questionnaire survey in two finnish universities

Summary This study describes Finnish university students' knowledge and attitudes towards HIV and AIDS, homosexuality and sexual risk behaviour. Finnish-speaking students were randomly selected from all registered students at two universities in Finland (N=9715, n=950). The data were collected by using a modified version of the State University of New York at Buffalo School of Nursing AIDS Study Questionnaire on sexual risk behaviour developed by Held and Chng. The total response rate was 35% (n=333). The data were analysed using quantitative statistical methods. Normally distributed data were analysed by t-test and one-way ANOVA, with Bonferroni corrections. Non-normally distributed data were analysed using the Mann-Whitney U-test and Kruskal-Wallis test, followed by a post-hoc test. The majority of students were familiar with HIV and AIDS, including its mode of transmission. However, there were still some misconceptions concerning HIV and AIDS. The oldest students and women had a more positive attitude towards people living with HIV and AIDS (PLWHA). Of patients with HIV or AIDS, intravenous drug users were perceived most negatively. Male students had more homophobic attitudes. Students who reported that religion had an important role in their lives had significantly stricter attitudes towards sexual risk behaviour. Students' knowledge correlated positively with general attitudes towards HIV and AIDS. Knowledge about HIV and AIDS will lead to more positive attitudes towards HIV and AIDS as a disease, towards those infected as well as homosexual people. There is a need to focus on preventive health care and sexual health promotion by educating young people and changing their attitudes towards sexual risk behaviour.     

Knowledge and beliefs of international travellers about the transmission and prevention of HIV infection.

OBJECTIVES: To measure the perceived risk of acquired immunodeficiency syndrome (AIDS) among international travellers, to measure their knowledge of the transmission and prevention of HIV infection abroad and to identify some of the determinants of this knowledge. DESIGN: Survey. SETTING: Travellers'' immunization clinic providing mostly primary preventive care to international travellers. PARTICIPANTS: All clients aged 18 to 50 years seen at the clinic between Oct. 2 and Dec. 21, 1989, before their departure. MAIN OUTCOME MEASURES: Sixteen statements measured knowledge of transmission and prevention of HIV infection. Standardized scales measured health beliefs. RESULTS: The response rate was 81% (331/409). Compared with other diseases AIDS was perceived to be associated with a low risk except by those travelling to countries with a high prevalence of AIDS. Most of the clients were found to have a good knowledge of HIV transmission to travellers, although some myths remained popular and some real routes of transmission, especially blood, remained underrated. In all, 70% of the subjects believed in the efficacy of condoms when used with local people, as compared with 79% when used with other tourists; this difference was greatest among travellers who perceived AIDS as being particularly severe but difficult to prevent. The determinants of the knowledge of HIV transmission and prevention were a high level of education, a mother tongue other than French, unmarried status, a high prevalence of AIDS at the destination, the duration of the trip and a high perceived risk of HIV infection. CONCLUSIONS: Counselling should teach travellers (a) not to underestimate their risk of HIV infection during their trip, (b) to decrease the risk of requiring health care in developing countries and (c) to rely on their own prudent sexual behaviour rather than on their assessment of the level of risk posed by the environment.     

Learning that circumcision is protective against HIV: risk compensation among men and women in Cape Town, South Africa

Objectives

We examined whether knowledge of the HIV-protective benefits of male circumcision (MC) led to risk compensating behavior in a traditionally circumcising population in South Africa. We extend the current literature by examining risk compensation among women, which has hitherto been unexplored.

Methods

We used data on Xhosa men and women from the 2009 Cape Area Panel Study. Respondents were asked if they had heard that MC reduces a man’s risk of contracting HIV, about their perceived risk of contracting HIV, and condom use. For each gender group we assessed whether risk perception and condom use differed by knowledge of the protective benefits of MC using bivariate and then multivariate models controlling for demographic characteristics, HIV knowledge/beliefs, and previous sexual behaviors. In a further check for confounding, we used data from the 2005 wave to assess whether individuals who would eventually become informed about the protective benefits of circumcision were already different in terms of HIV risk perception and condom use.

Results

34% of men (n = 453) and 27% of women (n = 690) had heard that circumcision reduces a man’s risk of HIV infection. Informed men perceived slightly higher risk of contracting HIV and were more likely to use condoms at last sex (p<0.10). Informed women perceived lower HIV risk (p<0.05), were less likely to use condoms both at last sex (p<0.10) and more generally (p<0.01), and more likely to forego condoms with partners of positive or unknown serostatus (p<0.01). The results were robust to covariate adjustment, excluding people living with HIV, and accounting for risk perceptions and condom use in 2005.

Conclusions

We find evidence consistent with risk compensation among women but not men. Further attention should be paid to the role of new information regarding MC, and drivers of HIV risk more broadly, in modulating sexual behavior among women.     

Evidence for recent changes in sexual behaviour in homosexual men in England and Wales

Over 80% of cases of Acquired Immune Deficiency Syndrome (AIDS) in England and Wales have occurred in homosexual men. Changes in sexual behaviour in this group may have a substantial influence on the incidence of Human Immunodeficiency Virus (HIV) infection and will therefore be crucial in determining future cases of AIDS. This paper critically weighs the indirect and direct evidence for changes in behaviour in homosexual men since the advent of the AIDS epidemic. The paper reports on falling incidence of gonorrhoea, hepatitis B and syphilis in homosexual men, the changes being most marked from 1985 onwards. Data on temporal trends in HIV prevalence and incidence in homosexual men are reviewed. These suggest that the maximum incidence of HIV infection occurred in 1982-84 and may have fallen since then. Evidence for a concomitant change in sexual behaviour is reported from several sources. This points towards a recent change in sexual behaviour characterized by reduction in the numbers of partners and adoption of safer sexual practices. In some places change may have occurred as early as 1983. A change became apparent generally in 1985 and this appears to have been sustained in 1986-87. Nevertheless, a substantial proportion of homosexual men studied continue to practice high risk sexual practices, such as anal intercourse, including relationships with casual partners.     

Women's lives and sex: Implications for AIDS prevention

Preliminary findings from the Women and AIDS program, a research grants program of the International Center for Research on Women in Washington, D.C. that supports 17 studies in developing countries worldwide, provide a glimpse into the complex interaction between women's social and economic status and risk of HIV infection. In many settings, the cultural norms that demand sexual fidelity and docile and acquiescent sexual behavior among women permit — and sometimes even encourage —early sexual experimentation, multiple partnerships, and aggressive and dominating sexual behavior among men. Drawing upon the findings from the program, the paper analyzes how such cultural norms, together with women's social and economic dependency, can limit a woman's ability to negotiate safer sex with her partner; restrict her access to information and knowledge about her body; force her to sometimes barter sex for survival; increase her vulnerability to physical violence in sexual interaction; and compromise her self-esteem. The findings highlight the limitations of the current HIV/AIDS prevention strategy for reducing women's risk of HIV, and underline the urgency for an approach to prevention that is grounded in the realities of women's lives and sexual experiences — an approach that recognizes the relationship between the dynamics of gender relations, sexual behavior, and HIV risk.     

“After my husband’s circumcision,I know that I am safe from diseases”: Women’s Attitudes and Risk Perceptions Towards Male Circumcision in Iringa,Tanzania

While male circumcision reduces the risk of female-to-male HIV transmission and certain sexually transmitted infections (STIs), there is little evidence that circumcision provides women with direct protection against HIV. This study used qualitative methods to assess women’s perceptions of male circumcision in Iringa, Tanzania. Women in this study had strong preferences for circumcised men because of the low risk perception of HIV with circumcised men, social norms favoring circumcised men, and perceived increased sexual desirability of circumcised men. The health benefits of male circumcision were generally overstated; many respondents falsely believed that women are also directly protected against HIV and that the risk of all STIs is greatly reduced or eliminated in circumcised men. Efforts to engage women about the risks and limitations of male circumcision, in addition to the benefits, should be expanded so that women can accurately assess their risk of HIV or STIs during sexual intercourse with circumcised men.     

Adolescent sexuality and the HIV epidemic in Yaoundé, Cameroon

Adolescents are the focus of many interventions that aim to prevent HIV transmission. In order for these interventions to be effective, it is essential to understand adolescents' sexual behaviour. Using data collected in Yaoundé, Cameroon, in 1997, the study analysed risk exposure and HIV prevalence among 426 men and 510 women aged 15-24. Although risky behaviours seem to be more prevalent among young men, their HIV prevalence remains under 1%. In contrast, HIV prevalence is high among young women (7.5%), even those who report having had few sexual partners. Mixing patterns among sexual partners, and especially the age difference between men and women, do not seem to be sufficient to explain the large male-female discrepancy in HIV prevalence that is evident in these data. The results are therefore probably due to a greater susceptibility to infection of young women than men. This study highlights the necessity of reinforcing prevention campaigns among youth and fighting the obstacles that continue to impede the use of condoms in this population.     

From awareness to adoption: the effect of AIDS education and condom social marketing on condom use in Tanzania (1993-1996)

This paper uses retrospective event-history data covering a four-year period to examine the timing of exposure to HIV/AIDS education and social marketing condom promotion campaigns, relative to the timing of changes in sexual risk behaviour in Tanzania. Analysis of the event-history data shows that the process of exposure to AIDS education messages and exposure to brand advertising for Salama brand condoms was very different. While exposure to AIDS education was early and gradual, exposure to Salama brand condoms started later, but was much more rapid. After one year of advertising, over half of the target population had been reached by the Salama advertising campaign, mostly through newspapers, radio and television. During the study period, condom use increased from 15% at the beginning of 1993 to 42% at the end of 1996. Increases in condom use were driven both by men who became sexually active, and by men who were not yet protected, or not fully protected. The results further show that it is uncommon for men who adopted condom use to return to more risky behaviour, which suggests that behaviour change in the study population is permanent.     

HIV/AIDS and Croatian migrant workers

Due to their geographical mobility and long periods of separation from intimate partners, migrant workers are at increased risk for a variety of sexually transmitted infections (STIs) including HIV/AIDS. This study sought to investigate patterns in HIV/AIDS related knowledge, attitudes and sexual behaviour in migrant workers in Croatia. In 2003, 566 male migrant workers were recruited during regular required medical examinations and surveyed at seven locations throughout the country. Each participant was asked to complete a self-administered KABP (sexual knowledge, attitudes, beliefs and practices) questionnaire. The average age of respondents was 38.2 years and the majority worked as seafarers (77.3%) and construction workers (20.5%). Only 18.5% of respondents were able to correctly answer all 13 questions assessing knowledge of HIV/AIDS. Seafarers reported higher levels of knowledge than did construction workers. The average respondent reported having had two sexual partners in the last 12 months, with slightly over half of the respondents (55.3%) reporting condom use at their last intercourse with a casual partner. One fifth of the respondents (20.3%) who reported having had intercourse with a sex worker during the last year reported not using condoms at last intercourse. The number of sexual partners was correlated with age, marital status, faith in God, and personal HIV risk assessment. Attitudes toward condom use, co-workers' HIV/AIDS concerns and the duration of migrant status (within the last two years) were shown to be significant correlates of condom use at last intercourse with a casual partner. The effect of HIV/AIDS related knowledge on analyzed behaviors did not reach statistical significance. Inadequate patterns of migrant workers' condom use, gaps in knowledge about HIV transmission and modes of protection, as well as widespread ignorance regarding available anonymous HIV testing found by this study suggest a critical need for expert intervention to avert the potential for an increase in new HIV/AIDS cases. A coordinated, systematic campaign for HIV/AIDS prevention among Croatian migrant workers should focus on increasing peer communication about HIV/AIDS, especially among younger migrant workers, and on reducing the frequency of sexual risk taking.     

Risky sexual behaviour among unmarried young people in Cameroon: another look at family environment

Most studies of the association between family structure and risky sexual behaviour among adolescents and young adults have employed a risk perspective which assumes that, compared with other types, two-parent families are protective. Drawing from a positive-oriented approach in this study, it is hypothesized that within each family type some influential factors may mitigate such anticipated deleterious effects of non-intact families and decrease sexual risk-taking. The paper examines specifically the effects of risk and protective factors with an emphasis on family processes associated with resilience, using data from a pooled sample of 1025 females and males aged 12-24 years from Bandjoun (West Cameroon). Findings show that the quality of parent/guardian-youth relationships significantly decreases the odds of risky sexual behaviour by 36%, 65% and 50% in neither-, one- and two-parent families, respectively. For two-parent families only, parental control acts as a significant protective factor; it decreased by 41% the odds of risky sexual behaviour. Programmatically, protective family factors such as parent/guardian-youth interactions need to be promoted to improve the efficiency of reproductive health and HIV interventions in sub-Saharan Africa.     

Patterns and Distribution of HIV among Adult Men and Women in India

Background

While the estimated prevalence of HIV in India experienced a downward revision in 2007, the patterning and distribution of HIV in the population remains unclear. We examined the individual and state-level socioeconomic patterning of individual HIV status among adult men and women in India as well as the patterning of other individual demographic and behavioral determinants of HIV status.

Methodology/Principal Findings

We conducted logistic regression models accounting for the survey design using nationally representative, cross-sectional data on 100,030 women and men from the 2005–2006 India National Family Health survey which, for the first time, provided objective assessments of HIV seroprevalence. Although there was a weak relationship between household wealth and risk of being HIV-positive, there was a clear negative relationship between individual education attainment and risk of being HIV-positive among both men and women. A 1000 Rupee change in the per capita net state domestic product was associated with a 4% and 5% increase in the risk for positive HIV status among men and women, respectively. State-level income inequality was associated with increased risk of HIV for men. Marital status and selected sexual behavior indicators were significant predictors of HIV status among women whereas the age effect was the most dominant predictor of HIV infection among men.

Conclusions/Significance

Although the prevalence of HIV in India is low, the lack of strong wealth patterning in the risk of HIV suggests a more generalized distribution of HIV risk than some of India''s high-risk group HIV prevention policies have assumed. The positive association between state economic development and individual risk for HIV is intriguing and requires further scrutiny.     

The Relationship Between Scientific Knowledge and Behaviour: An HIV/AIDS Case

Debates on the role of scientific knowledge to affect behaviour are continuing. The theory of planned behaviour suggests that behaviour is influenced by attitudes, subjective norms and perceived behavioural control and not by knowledge. However, a large body of knowledge argues that increased HIV/AIDS-related knowledge leads to the adoption of safe behavioural practices. The purpose of this non-experimental survey study, therefore, was to investigate the correlation between academic HIV/AIDS knowledge, functional HIV/AIDS knowledge and self-reported behavioural preferences of 300 biology and 243 non-biology students from nine South African schools. Results suggest a correlation between students’ understanding of academic and functional HIV/AIDS knowledge. The behavioural preferences of both biology and non-biology students were generally the same and safe. Among biology students, correlation was observed between academic HIV/AIDS knowledge and self-reported safe behavioural preferences, which was not the case for non-biology students, where functional HIV/AIDS knowledge correlated with self-reported safe behavioural preferences. Within schools, however, no correlation was found between both forms of HIV/AIDS knowledge and self-reported safe behavioural preferences. There were indications that context-specific local factors have a greater influence on behavioural preferences. These findings suggest that the type of knowledge that could influence behaviour is informed by context-specific dynamics.     

Patterns of sexual behaviour and reported symptoms of STI/RTIs among young people in Croatia--implications for interventions' planning

This paper describes some of the results of the first national-level survey on sexual behaviour and the distribution of risks to sexually transmitted infections (STIs), including human immunodeficiency virus infection (HIV), among youth in Croatia, and the nature and the extent of their vulnerability to these adverse health outcomes. The study was a cross-sectional, probability-based household survey conducted in 2005, and included 1093 respondents aged 18-24. This paper aims to describe the findings related to the knowledge of HIV transmission, key behavioural outcomes relevant for potential transmission of HIV and STIs, and correlates of genital discharge in young men and young women. More than 80% of young people know that the correct use of condoms protects against HIV and that HIV can be transmitted by someone who looks healthy. Fifty-nine percent of young men and 52.4% of young women reported using condoms during the first sexual intercourse, and 59.3% of men and 46.1% of women used condoms during the last sexual intercourse with a casual partner. This points to the gap between knowledge of condom use and the actual use of condoms as a high proportion of risky sexual contact remain unprotected. Having sexual intercourse frequently or regularly while consuming alcohol was reported by 19.2% of men and 7.6% of women. Much lower proportion are using drugs frequently or regularly during sexual intercourse (3.7% of men and 2.1% of women). Among those sexually experienced, 11.8% of men and 44.1% of women reported ever having a genital discharge. Higher presence of genital discharge in women is suggestive of reproductive tract infections that are not necessarily sexually transmitted. In the multivariate analysis, the lack of knowledge of whether chlamydial infections is an STI and having more than five partners in life were correlates of genital discharge in men, while in women the correlates included having more than five partners in life and not using condoms during the first sexual intercourse. Higher burden of STI-related symptoms was found among men who have men as sexual partners, those who paid for sex, and those with concurrent partnerships. These findings point out to the immediate need to strengthen sexual health education among young people and to the necessity for further development of other broad-based interventions to prevent adverse sexual health outcomes among both men and women, as well as those targeted towards more vulnerable subgroups.     

Geoadditive latent variable modeling of count data on multiple sexual partnering in Nigeria

The 2005 National HIV/AIDS and Reproductive Health Survey (NARHS) in Nigeria provides evidence that multiple sexual partnering increases the risk of contracting HIV and other sexually transmitted diseases. Therefore, partner reduction is one of the prevention strategies to accomplish the Millenium Development Goal of halting and reversing the spread of HIV/AIDS. We consider the numbers of girlfriends, casual, and commercial partners of heterosexual men, reported in the NARHS study, as observed indicators of their latent attitude toward multiple partnering. To explore the influence of risk factors on this latent variable, we extend semiparametric methodology for latent variable models with continuous and categorical indicators to include count indicators. This allows us to simultaneously analyze linear and nonlinear effects of covariates, such as sociodemographic factors and knowledge about HIV/AIDS, on attitude toward multiple sexual partnering, which in turn influences the observable count indicators. The results provide insights for policy makers who are aiming to reduce the spread of HIV and AIDS among the Nigerian populace through partner reduction.     

HIV Prevalence Correlates with High-Risk Sexual Behavior in Ethiopia's Regions

Background

HIV prevalence varies between 0.9 and 6.5% in Ethiopia’s eleven regions. Little has been published examining the reasons for this variation.

Methods

We evaluated the relationship between HIV prevalence by region and a range of risk factors in the 2005 and 2011 Ethiopian Demographic Health Surveys. Pearson’s correlation was used to assess the relationship between HIV prevalence and each variable.

Results

There was a strong association between HIV prevalence and three markers of sexual risk: mean lifetime number of partners (men: r = 0.87; P < 0.001; women: r = 0.60; P = 0.05); reporting sex with a non-married, non-cohabiting partner (men: r = 0.92; P < 0.001, women r = 0.93; P < 0.001); and premarital sex. Condom usage and HIV testing were positively associated with HIV prevalence, while the prevalence of circumcision, polygamy, age at sexual debut and male migration were not associated with HIV prevalence.

Conclusion

Variation in sexual behavior may contribute to the large variations in HIV prevalence by region in Ethiopia. Population-level interventions to reduce risky sexual behavior in high HIV incidence regions should be considered.     

Gender inequality increases women's risk of hiv infection in Moshi, Tanzania

This study examined the hypothesis that multiple dimensions of gender inequality increase women's risk for HIV infection using a population-based survey of 1418 women aged 20 to 44 in Moshi, Tanzania. Three forms of HIV exposures were assessed reflecting gender power imbalance: economic exposures (age difference between partners and partner's contributions to children's expenses), physical exposures (coerced first sex and intimate partner violence) and social exposures (ever had problems conceiving). Behavioural risk factors included number of sexual partners for women in the last three years, partner had other wives or girlfriends, non-use of condom and alcohol use at least once a week in the last 12 months. Multivariate logistic regression analysis showed that a woman had a significantly elevated risk for HIV if she had a partner more than 10 years older (OR=2.5), her partner made low financial contributions to children's expenses (OR=1.7), or she experienced coerced first sex before age 18 years (OR=2.0) even after taking into account the effects of risk behaviour factors. The association between ever had problem conceiving and HIV infection was explained away by risk behaviour factors. The findings lend support to the hypothesis that economic deprivation and experience of sexual violence increase women's vulnerability to HIV, providing further evidence for extending the behavioural approach to HIV interventions to incorporate women's economic empowerment, elimination of gender-based violence and promotion of changing attitudes and behaviours among men.     

Tracking the evolution of HIV/AIDS in China from 1989-2009 to inform future prevention and control efforts

Background

To determine policy implications, this analysis tracks the evolution of HIV/AIDS infection across China to understand current trends and potential risk factors.

Methods and Principal Findings

A retrospective study with spatial analytical model and multilevel spatial models was conducted among 326,157 HIV/AIDS cases reported from 1989–2009. The results indicate that the distribution of HIV/AIDS was clustered at the county level with different directional distributions across China from 2003 to 2009. Compared to 2003, by 2009 there was a 122% increase in HIV cases among rural residents, 294% increase among urban residents, 211% increase among migrants, and 237% increase among permanent residents. The overall proportion of HIV by different routes of transmission showed dramatic changes with a 504% increase in sexual transmission of HIV, 90% decrease in blood/plasma transmission, and 35% decrease in injecting drug user transmission. Sexual transmission was the major transmission route among women (44%) and the elderly (59% in men, 44% in women) as well as among permanent (36%) and urban residents (33%). Among those <65 years old, women increased more than men, but among those ≥65 years, men increased more than women. Migrants contributed to the variance of HIV infection between counties but not within counties. The length of highway and urbanization combined with illiteracy were risk factors for HIV/AIDS.

Conclusions/Significance

Rates of HIV/AIDS among permanent urban residents, particularly women and elderly men, have increased significantly in recent years. To prevent HIV from spreading further among the general population, additional attention should be paid to these populations as well as to migrants.     

Poverty, sexual experience and hiv vulnerability risks: evidence from addis ababa, ethiopia

Summary This study explores the relationship between poverty and vulnerability to HIV infection in Ethiopia using primary (quantitative and qualitative) and secondary data from two sub-cities of Addis Ababa. The data show that sexual experience is influenced by diverse factors such as age, gender, economic status and education level. Household economic status and migration explain the nature of sexual experience and level of vulnerability to HIV infection. Poor uneducated women in poor neighbourhoods are more likely to engage in risky sexual encounters despite awareness about the risk of HIV infection as they operate in an environment that provides the 'path of least resistance' (Lindegger & Wood, 1995, p. 7). This article argues that poverty provides a situation where early sexual initiation, 'transactional sex' and an inability to negotiate for safer sex are associated with low income, lack of education and increased vulnerability to HIV infection. This vulnerability is simultaneously contested and accepted as a commitment to even sacrifice one's life for the sake of one's loved ones. As a modest contribution to the 'structural violence' approach, which emphasizes social inequalities based on gender, class, ethnicity and race and inequalities in terms of exposure to risk and access to health care (Massé, 2007), this article challenges the 'African promiscuity' discourse, which 'does not permit policymakers to think beyond sex' (Stillwaggon, 2006, p. 156), and encourages researchers and policymakers to ask the right questions to understand the complexity of HIV/AIDS and seek solutions to the pandemic.