title: Community-level income inequality and HIV prevalence among persons who inject drugs in Thai Nguyen, Vietnam.
abstract: Socioeconomic status has a robust positive relationship with several health outcomes at the individual and population levels, but in the case of HIV prevalence, income inequality may be a better predictor than absolute level of income. Most studies showing a relationship between income inequality and HIV have used entire countries as the unit of analysis. In this study, we examine the association between income inequality at the community level and HIV prevalence in a sample of persons who inject drugs (PWID) in a concentrated epidemic setting. We recruited PWID and non-PWID community participants in Thai Nguyen, Vietnam, and administered a cross-sectional questionnaire; PWID were tested for HIV. We used ecologic regression to model HIV burden in our PWID study population on GINI indices of inequality calculated from total reported incomes of non-PWID community members in each commune. We also modeled HIV burden on interaction terms between GINI index and median commune income, and finally used a multi-level model to control for community level inequality and individual level income. HIV burden among PWID was significantly correlated with the commune GINI coefficient (r = 0.53, p = 0.002). HIV burden was also associated with GINI coefficient (β = 0.082, p = 0.008) and with median commune income (β = -0.018, p = 0.023) in ecological regression. In the multi-level model, higher GINI coefficient at the community level was associated with higher odds of individual HIV infection in PWID (OR = 1.46 per 0.01, p = 0.003) while higher personal income was associated with reduced odds of infection (OR = 0.98 per $10, p = 0.022). This study demonstrates a context where income inequality is associated with HIV prevalence at the community level in a concentrated epidemic. It further suggests that community level socioeconomic factors, both contextual and compositional, could be indirect determinants of HIV infection in PWID.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States.
authors.forename: Travis W
authors.initials: TW
authors.lastname: Lim
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, Maryland, United States.
authors.forename: Constantine
authors.initials: C
authors.lastname: Frangakis
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland, United States.
authors.forename: Carl
authors.initials: C
authors.lastname: Latkin
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States.
authors.forename: Tran Viet
authors.initials: TV
authors.lastname: Ha
authors.affiliation: Thai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam.
authors.forename: Nguyen Le
authors.initials: NL
authors.lastname: Minh
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States.
authors.forename: Carla
authors.initials: C
authors.lastname: Zelaya
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States.
authors.forename: Vu Minh
authors.initials: VM
authors.lastname: Quan
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States.
authors.forename: Vivian F
authors.initials: VF
authors.lastname: Go
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D055030:Drug Users; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012111:Residence Characteristics; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult