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- Title
Investigating the Associations between Drought, Poverty, High-Risk Sexual Behaviours, and HIV Incidence in Sub-Saharan Africa: A Cross-Sectional Study.
- Authors
Trickey, Adam; Johnson, Leigh F.; Bonifacio, Rogerio; Kiragga, Agnes; Howard, Guy; Biraro, Samuel; Wagener, Thorsten; Low, Andrea; Vickerman, Peter
- Abstract
Climate change is increasing the likelihood of drought in sub-Saharan Africa, where HIV prevalence is high. Drought could increase HIV transmission through various mediating mechanisms; we investigated these associations. We used data on people aged 15–59 from Population-Based HIV Impact Assessment surveys from 2016 in Eswatini, Lesotho, Tanzania, Uganda, and Zambia. Survey data were geospatially linked to precipitation data for 2014–2016, with local droughts defined as cumulative rainfall between 2014 and 2016 being in < 15th percentile of all 2-year periods over 1981–2016. Using multivariable logistic regression, stratified by sex and rural/urban residence, we examined associations between (a) drought and poverty, (b) wealth quintiles and sexual behaviours (transactional, high-risk, and intergenerational sex), (c) sexual behaviours and recently acquiring HIV, and (d) drought and recent HIV. Among 102,081 people, 31.5% resided in areas affected by drought during 2014–2016. Experiencing drought was positively associated with poverty for women and men in rural, but not urban, areas. For each group, increasing wealth was negatively associated with transactional sex. For rural women, intergenerational sex was positively associated with wealth. Women reporting each sexual behaviour had higher odds of recent HIV, with strong associations seen for high-risk sex, and, for urban women, intergenerational sex, with weaker associations among men. Women in rural areas who had been exposed to drought had higher odds of having recently acquired HIV (2.10 [95%CI: 1.17–3.77]), but not women in urban areas, or men. Droughts could potentially increase HIV transmission through increasing poverty and then sexual risk behaviours, particularly among women in rural areas.
- Subjects
UGANDA; ZAMBIA; TANZANIA; LESOTHO; SUB-Saharan Africa; HIV infection transmission; HIV infection epidemiology; CROSS-sectional method; RISK-taking behavior; RESEARCH funding; RURAL health; HUMAN sexuality; CLIMATE change; MULTIPLE regression analysis; SEX distribution; DISEASE prevalence; POPULATION geography; SEX customs; SURVEYS; ODDS ratio; CONCEPTUAL structures; CONFIDENCE intervals; NATURAL disasters; POVERTY; INTERGENERATIONAL relations
- Publication
AIDS & Behavior, 2024, Vol 28, Issue 5, p1752
- ISSN
1090-7165
- Publication type
Article
- DOI
10.1007/s10461-024-04280-8