Social-structural indices and between-nation differences in HIV prevalence.
Research emphasises the role that social structures play in shaping national HIV prevalence. This study examined how social, economic, and political contexts that may represent the confluence of individual capabilities and environmental affordances or constraints are associated with national HIV prevalence. Based on social-ecological perspectives, we examined social-structural dimensions in relation to national HIV prevalence. The study identified six publicly available nation-level social, political, and economic indices and examined their associations with national 2009 HIV prevalence across 225 nations. National indices, (a) education expenditures, (b) unemployment rate, (c) homicide rate, (d) freedom of religion, and (e) women's social rights, altogether explained 43% of the variability in national HIV prevalence. Education expenditures, homicide rate, and freedom of religion were significant predictors of national HIV prevalence in the multivariate analysis. The present study identified nation-level factors that capture social, economic, and political contexts to explain between-nation differences in HIV prevalence. Findings extend current literature on the social-structural foundation of HIV-risk and the relationship between human rights and health. National safeguards that afford individuals the power to promote general quality of life and protection from structural violence may be most important to lowering overall rates of HIV transmission.
Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA judy.tan@ucsf.edu.
Judy Y
JY
Tan
Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
Valerie A
VA
Earnshaw
Department of Psychology, University of Connecticut, Storrs, Connecticut, USA.
Felicia
F
Pratto
Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
Lisa
L
Rosenthal
Department of Psychology, University of Connecticut, Storrs, Connecticut, USA.
Seth
S
Kalichman
D000328:Adult; D003431:Cross-Cultural Comparison; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006806:Human Rights; D006801:Humans; D008297:Male; D011057:Politics; D015995:Prevalence; D016016:Proportional Hazards Models; D011788:Quality of Life; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D014933:Women's Rights
AIDS; HIV; National HIV prevalence; epidemiology; human rights; national indices; power; risk factors; social and structural factors