The who and where of HIV in rural Malawi: Exploring the effects of person and place on individual HIV status.
Few spatial studies explore relationships between people and place in sub-Saharan Africa or in the context of human immunodeficiency virus (HIV). This paper uses individual-level demographic and behavioral data linked to area-level, spatially referenced socio-economic and access data to examine how the relationships between area- and individual-level risks and individual HIV status vary in rural Malawi. The political economy of health framework guides interpretation. Geographically weighted regression models show significant, local-level variation indicating that area-level factors drive patterns of HIV above individual-level contributions. In distinct locations, women who live further from health clinics, major roads, and major cities are less likely to be infected. For men, HIV status is strongly associated with migration patterns in specific areas. Local-level, gender-specific approaches to HIV prevention are necessary in high risk areas.
Feldacker
Caryl
C
Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, USA. cfeldacker@gmail.com
Emch
Michael
M
Ennett
Susan
S
D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006297:Health Services Accessibility; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012423:Rural Health / Q000706:statistics & numerical data; D017678:Sex Distribution; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult