Armed Conflict, Substance Use and HIV: A Global Analysis.
Armed conflict is frequently assumed to be a contributor to the global HIV epidemic, but existing evidence is sparse. We examined the relationship between armed conflict between 2002 and 2008 and HIV disability life years (DALYs) in 2010 among WHO Member States. Using partial least squares analysis we also examined moderation of the armed conflict-HIV link by two susceptibility constructs (background risk, substance use) and one vulnerability mediator (numbers of refugees, people on ART, and total HIV spending). Background risk directly impacted HIV DALYs (p < 0.05), substance use moderated the conflict-HIV relationship (p < 0.01). The vulnerability construct mediated the conflict-HIV association (p < 0.01). Findings underscore the need to align HIV prevention/intervention efforts with pre-existing HIV burden and reduce the impact of natural disasters on the populace in conflict-affected states. Integration of substance prevention/harm reduction programs within national HIV responses, attention to most-at-risk populations and increased surveillance/treatment of drug resistant HIV and TB is warranted.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA. bradleykerridge@gmail.com.
Bradley T
BT
Kerridge
Division of Intramural Clinical and Biological Research, National Institutes on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
Tulshi D
TD
Saha
Department of Psychiatry, College of Physicians and Surgeons, Mailman School of Public Health, New York State Psychiatric Institute, Columbia University, New York, NY, 10032, USA.
Deborah S
DS
Hasin
D000068337:Armed Conflicts; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D014943:Global Health / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology*; D040261:Harm Reduction; D005102:Health Expenditures; D006801:Humans; D008017:Life Expectancy; D012036:Refugees / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014857:Warfare
Conflict; Disasters; HIV; Partial least squares structural equation modeling; Refugees; Substance use; Terrorism