title: The role of communication inequality in mediating the impacts of socioecological and socioeconomic disparities on HIV/AIDS knowledge and risk perception.
abstract: BACKGROUND
  Although the link between social factors and health-related outcomes has long been widely acknowledged, the mechanisms characterizing this link are relatively less known and remain a subject of continued investigation across disciplines. In this study, drawing on the structural influence model of health communication, the hypothesis that differences in concern about and information needs on HIV/AIDS, HIV/AIDS-related media use, and perceived salience of HIV/AIDS-related information, characterized as communication inequality, can at least partially mediate the impacts of socioecological (urban vs. rural) and socioeconomic (education) disparities on inequalities in HIV/AIDS knowledge and risk perception was tested.
  
  
  METHODS
  Data were collected from a random sample of 986 urban and rural respondents in northwest Ethiopia. Structural equation modeling, using the maximum likelihood method, was used to test the mediation models.
  
  
  RESULTS
  The models showed an adequate fit of the data and hence supported the hypothesis that communication inequality can at least partially explain the causal mechanism linking socioeconomic and socioecological factors with HIV/AIDS knowledge and risk perception. Both urbanity versus rurality and education were found to have significant mediated effects on HIV/AIDS knowledge (urbanity vs. rurality: β = 0.28, p = .001; education: β = 0.08, p = .001) and HIV/AIDS risk perception (urbanity vs. rurality: β = 0.30, p = .001; education: β = 0.09, p = .001).
  
  
  CONCLUSIONS
  It was concluded that communication inequality might form part of the socioecologically and socioeconomically embedded processes that affect HIV/AIDS-related outcomes. The findings suggest that the media and message effects that are related to HIV/AIDS behavior change communication can be viewed from a structural perspective that moves beyond the more reductionist behavioral approaches upon which most present-day HIV/AIDS communication campaigns seem to be based.
authors: Bahir Dar University, Bahir Dar, Ethiopia. mesfiab@yahoo.com.
authors: Mesfin Awoke
authors: MA
authors: Bekalu
authors: Steven
authors: S
authors: Eggermont
mesh_terms: D000293:Adolescent; D000328:Adult; D005002:Ethiopia; D005260:Female; D015658:HIV Infections; D058015:Health Communication / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D010465:Perception; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult