What explains gender inequalities in HIV/AIDS prevalence in sub-Saharan Africa? Evidence from the demographic and health surveys.
Women are disproportionally affected by human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in sub-Saharan Africa (SSA). The determinants of gender inequality in HIV/AIDS may vary across countries and require country-specific interventions to address them. This study aimed to identify the socio-demographic and behavioral characteristics underlying gender inequalities in HIV/AIDS in 21 SSA countries.



We applied an extension of the Blinder-Oaxaca decomposition approach to data from Demographic and Health Surveys and AIDS Indicator Surveys to quantify the differences in HIV/AIDS prevalence between women and men attributable to socio-demographic factors, sexual behaviours, and awareness of HIV/AIDS. We decomposed gender inequalities into two components: the percentage attributable to different levels of the risk factors between women and men (the "composition effect") and the percentage attributable to risk factors having differential effects on HIV/AIDS prevalence in women and men (the "response effect").



Descriptive analyses showed that the difference between women and men in HIV/AIDS prevalence varied from a low of 0.68 % (P = 0.008) in Liberia to a high of 11.5 % (P < 0.001) in Swaziland. The decomposition analysis showed that 84 % (P < 0.001) and 92 % (P < 0.001) of the higher prevalence of HIV/AIDS among women in Uganda and Ghana, respectively, was explained by the different distributions of HIV/AIDS risk factors, particularly age at first sex between women and men. In the majority of countries, however, observed gender inequalities in HIV/AIDS were chiefly explained by differences in the responses to risk factors; the differential effects of age, marital status and occupation on prevalence of HIV/AIDS for women and men were among the significant contributors to this component. In Cameroon, Guinea, Malawi and Swaziland, a combination of the composition and response effects explained gender inequalities in HIV/AIDS prevalence.



The factors that explain gender inequality in HIV/AIDS in SSA vary by country, suggesting that country-specific interventions are needed. Unmeasured factors also contributed substantially to the difference in HIV/AIDS prevalence between women and men, highlighting the need for further study.
Département des sciences infirmières, Campus de Saint-Jérôme, Université du Québec en Outaouais, 5, rue Saint-Joseph, bureau J-3226, Saint Jérôme, Québec, J7Z 0B7, Canada. drissa.sia@uqo.ca.
Drissa
0000-0003-0044-8465
D
Sia
Institut Supérieur des Sciences de la Population (ISSP), Université Ouaga I Pr Joseph Ki-Zerbo, 03 BP 7118 Ouagadougou 03, Ouagadougou, Burkina Faso.
Yentéma
Y
Onadja
School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada.
Mohammad
M
Hajizadeh
Fielding School of Public Health, The University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
S Jody
SJ
Heymann
David Geffen School of Medicine, The University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Timothy F
TF
Brewer
Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada.
Arijit
A
Nandi
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D002163:Cameroon / Q000453:epidemiology; D013541:Eswatini / Q000453:epidemiology; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D012725:Sexual Behavior; D014454:Uganda / Q000453:epidemiology
Blinder-Oaxaca decomposition; Gender inequality; HIV/AIDS; Sub-Saharan Africa