Background: Previous reports on sexual behaviours and risks of HIV infection in relation to socioeconomic status of women were contradictory. The purpose of this study was to determine the consistency of risky sexual behaviour among women with regard to their age, residence, educational level and wealth index. Methods: Subgroup and pooled meta-analysis was done on risky sexual behaviour and HIV prevalence of women aged 15 - 49 years using the recent Demographic and Health Surveys data (DHS 2003-2009) from 28 countries in and outside Africa. Pooled and individual countries odds ratios were calculated using Mantel-Haenszel (M-H) statistical method. Random effect analytic model was applied since there was significant heterogeneity among surveys (I 2 > 50%). Sensitivity analysis was also done to examine the effect of outliers. Results: Out of 207,776 women reported to have sex within 12 months prior to the respective surveys, 36,530 (17.6%) were practicing higher-risk sex. Risky sexual behavior was found to have statistically significant association with women living in urban areas, attained secondary and above education and owned middle to highest wealth index. Sensitivity analysis demonstrated the stability of the pooled odds ratios for outliers. Better education attainment, high wealth index and being employed were also associated with high HIV prevalence. Conclusion: This analysis has shown the high prevalence of higher-risk sexual behaviour and high HIV infection among wealthier and better educated women regardless of geographic location of the selected low to middle income countries. Further study is required to establish how and why being good in socioeconomic status associated with risky sexual behaviour.
Joint United Nations Programme on HIV/AIDS (UN-AIDS), “2010 Report on the Global AIDS Epidemic”. www.unaids.org
J. Hargreaves and T Boler, “Girl Power: The Impact of Girls’ Education on HIV and Sexual Behaviour,” Action Aid International, 2006. www.actionaid.org.uk/doc_lib/girl
N. Madise, E. Zulu and J. Ciera, “Is Poverty a Driver for Risky Sexual Behaviour? Evidences from National Surveys of Adolescents in Four African Countries,” African Journal of Reproductive Health, Vol. 11, No. 3, 2007, pp. 83-98. doi:10.2307/25549733
V. Mishra, S. B. V. Assche, R. Greener, M. Vaessen, R. Hong, P. D. Ghys, et al., “HIV Infection Does not Disproportionately Affect the Poorer in Sub-Saharan Africa,” AIDS, Vol. 21, No. 7, 2007, pp. 17-28. doi:10.1097/01.aids.0000300532.51860.2a
J. R. Hargreaves and J. R. Glynn, “Educational Attainment and HIV-1 infection in Developing Countries: A Systematic Review,” Tropical Medicine and International Health, Vol. 7, No. 6, 2002, pp. 489-498. doi:10.1046/j.1365-3156.2002.00889.x
Centers for Disease Control and Prevention, “HIV/AIDS Surveillance Report, 2007”. http://www.cdc.gov/hiv/topics/surveillance/
D. R. Holtgrave and R. A. Crosby, “Social Capital, Poverty, and Income Inequality as Predictors of Gonorrhoea, Syphilis, Chlamydia and AIDS Case Rates in the United States,” Sexually Transmitted Infection, Vol. 79, No. 1, 2003, pp. 62-64. doi:10.1136/sti.79.1.62
J. A. Higgins, S. Hoffman and S. L. Dworkin, “Re-Thinking Gender, Heterosexual Men, and Women’s Vulnerability to HIV/AIDS: Time to Shift the Paradigm,” American Journal of Public Health, Vol. 100, No. 3, 2010, pp. 435-445.
S. Leclerc-Madlala, “Age-Disparate and Intergenerational Sex in Southern Africa: The Dynamic of Hyper Vulnerability,” AIDS, Vol. 22, No. 4, 2008, pp. 17-24. doi:10.1097/01.aids.0000341774.86500.53
L. Fenton, “Preventing HIV/AIDS through Poverty Reduction: The Only Sustainable Solution,” The Lancet, Vol. 364, No. 9440, 2004, pp. 1186-1187. doi:10.1016/S0140-6736(04)17109-2
B. Lopman, J. Lewis, C. Nyamukapa, P. Mushati, S. Chandiwana and S. Gregson, “HIV Incidence and Poverty in Manicaland, Zimbabwe: Is HIV Becoming a Disease of The Poor?” AIDS, Vol. 21, No. 7, 2007, pp. 57-66. doi:10.1097/01.aids.0000300536.82354.52
D. E. Bloom and J. Sevilla, “Health, Wealth, AIDS, and Poverty,” Report of the Asia-Pacific Ministerial Meeting, The Australian Government Overseas Aid Programme, Melbourne, 9-10 October 2001. www.ausaid.gov.au/publications/pdf/health_wealth_poverty
UNDP, “HIV/AIDS Implications for Poverty Reduction,” 2001. www.worldbank.org/INTHIVAIDS
L. Robertson, P. Mushati, J. Eaton, et al., “P1-S6.04 Education and Lifetime Risk of HIV Infection in Manicaland, Zimbabwe,” Sexually Transmitted Infection, Vol. 87, No. 1, 2011, p.197. doi:10.1136/sextrans-2011-050108.228
A. K. Asare and S. K. Annim, “Wealth Status and Risky Sexual Behaviour in Ghana and Kenya,” Applied Health Economics and Health Policy, Vol. 6, No. 1, 2008, pp. 27-39. doi:10.2165/00148365-200806010-00003
C. T. Kirunga and J. P. M. Ntozi, “Socio-Economic Determinants of HIV Serostatus: A Study of Rakai District, Uganda,” Health Transition Review, Vol. 7, No. 1, 1997, pp. 175-188.
Demographic and Health Survey, Publication Search by Country. http://www.measuredhs.com/pubs/search_results.cfm
Demographic Health Survey Questionnaires and Modules, “HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Module”. http://www.measuredhs.com/pubs/DHSQM/DHS
A. D. Burgoyne and P. D. Drummond, “Knowledge of HIV and AIDS in Women in Sub-Saharan Africa,” African Journal of Reproductive Health, Vol. 12, No. 2, 2008; pp. 14-31.
International Center for Research on Women, “Can Economic Empowerment Reduce Vulnerability of Girls and Young Women to HIV? Emerging Insights,” 2010. http://www.populationreports.org/m18/
S. D. Weiser, K. Leiter, D. R. Bangsberg, L. M. Butler, F. P. Korte, Z. Hlanze, N. Phaladze, V. Iacopino and M. Heisler, “Food Insufficiency Is Associated with High-Risk Sexual Behavior among Women in Botswana and Swaziland,” PLoS Medicine, Vol. 4, No. 3, 2007, p. e260. http://www.plosmedicine.org/article/info
C. Li, P. Jha, B. Stirling, S. K. Sgaier, T. Daid, R. Kaul and N. Nagelkerke, “Sexual Risk Factors for HIV Infection in Early and Advanced HIV Epidemics in Sub-Saharan Africa: Systematic Overview of 68 Epidemiological Studies,” PLoS ONE, Vol. 2, No. 10, 2007, p. e1001. http://www.plosone.org/article/info doi:10.1371/journal.pone.0001001
K. Awusabo-Asari and S. K. Annim, “Wealth Status and Risky Sexual Behaviour in Ghana and Kenya,” Applied Health Economics and Health Policy, Vol. 6, No. 1, 2008, pp. 27-39. doi:10.2165/00148365-200806010-00003
K. Eugene, W. Charles, M. Robinson, N. Philip, L. Kouam, “Wealth and Sexual Behaviour among Men in Cameroon,” BMC International Health Human Rights, Vol. 6, No. 11, 2006. www.biomedcentral.com/bmcinthealthhum
Joint United Nations Programme on HIV/AIDS (UN-AIDS), “2008 Report on the Global AIDS Epidemic”. www.unaids.org
D. Upreti, P. Regmi, P. Pant, P. Sinkhada, “Young People’s Knowledge, Attitude, and Behaviour on STI/HIV/AIDS in the Context of Nepal: A Systematic Review,” Kathmandu University Medical Journal, Vol. 7, No. 4, 2009, pp. 383-391.
M. Aoife, A. David, M. Kaballa, B. Kathy, M. Clemens, A. Aura, L. Mary, I. N. Angela, A. Helen, K. Saidi, W. Deborah, C. John, J. Richard, “Long-Term Biological and Behavioural Impact of an Adolescent Sexual Health Intervention in Tanzania: Follow-Up Survey of the Community-Based MEMA kwa Vijana Trial,” PLoS Medicine, Vol. 7, No. 6, 2010, p. e1000287. http://www.plosmedicine.org/article/info doi:10.1371/journal.pmed.1000287
V. A. Paul-Ebhohimhen, A. Poobalan and E. R. Van Teijlingen, “A systematic Review of School-Based Sexual Health Interventions to Prevent STI/HIV in Sub-Saharan Africa,” BMC Public Health, Vol. 8, No. 4, 2008. http://www.biomedcentral.com/ doi:10.1186/1471-2458-8-4
S. Gillespie, S. Kadiyala and R. Greener, “Is Poverty or Wealth Driving HIV Transmission?” AIDS, Vol. 21, No. 7, 2007, pp. 5-16. doi:10.1097/01.aids.0000300531.74730.72
M. Vinoda, A. S. Bignami-Vanb, G. Robertc, V. Mrtina, H. Rathavutha, P, D, Ghys, B. J. Tiesd, V. A. Arie, K. Shanea, R.. Sheaa, “HIV Infection Does Not Dispropor- tionately Affect the Poorer in Sub-Saharan Africa,” AIDS, Vol. 21, No. 7, 2007, pp. 17- 28. doi:10.1097/01.aids.0000300532.51860.2a
A. M. Fox, “The Social Determinants of HIV Serostatus in Sub-Saharan Africa: An Inverse Relationship between Poverty and HIV?” Public Health Reproductive, Vol. 125, No. 4, 2010, pp. 16-24.
A. Delavande and H. Kohler, “HIV-Related Expectations and Risky Sexual Behaviour in Malawi,” 2011. http://repository.upenn.edu/psc_working_papers/28
S. Luchters, A. Sarna, S. Geibel, M. F. Chersich, P. Munyao, S. Kaai, et al., “Safer Sexual Behaviors after 12 Months of Antiretroviral Treatment in Mombasa, Kenya: A Prospective Cohort,” AIDS Patient Care STDS, Vol. 22, No. 7, 2008, pp. 587-594. doi:10.1089/apc.2007.0247
T. P. Eisele, C. Mathews, M. Chopra, M. N. Lurie, L. Brown, S. Dewing and C. Kendall, “Changes in Risk Behavior among HIV-Positive Patients during Their First Year of Antiretroviral Therapy in Cape Town South Africa,” AIDS and Behavior, Vol. 13, No. 6, 2009, pp. 1097-1105. doi:10.1007/s10461-008-9473-2
R. Bunnell, J. P. Ekwaru, P. Solberg, N. Wamai, W. Bikaako-Kajura, W. Were, et al., “Changes in Sexual Behavior and Risk of HIV Transmission after Antiretroviral Therapy and Prevention Interventions in Rural Uganda,” AIDS, Vol. 20, No. 1, 2006, pp. 85-92. doi:10.1097/01.aids.0000196566.40702.28
S. Diabate, M. Alary and C. K. Koffi, “Short-Term Increase in Unsafe Sexual Behaviour after Initiation of HAART in Cote d’Ivoire,” AIDS, Vol. 22, No. 1, 2008, pp. 154-156.
L. Sherr, B. Lopman, M. Kakowa, S. Dube, G. Chawira, C. Nyamukapa, N. Oberzaucher, I. Cremin and S. Gregson, “Voluntary counselling and Testing: Uptake, Impact on Sexual Behaviour, and HIV Incidence in a Rural Zimbabwean Cohort,” AIDS, Vol. 21, No. 7, 2007, pp. 851-860. doi:10.1097/QAD.0b013e32805e8711
C. Wang, S. E. Hawes, A. Gaye, et al., “HIV Prevalence, Previous HIV Testing, and Condom Use with Clients and Regular Partners among Senegalese Commercial Sex Workers,” Sexually Transmitted Infection, Vol. 83, No. 7, 2007, pp. 534-540.
A. N. Turner, W. C. Miller, N. S. Padian, J. S. Kaufman, F. M. Behets, T. Chipato, F. A. Mmiro, R. A. Salata and C. S. Morrison, “Unprotected Sex following HIV Testing among Women in Uganda and Zimbabwe: Short- and Long-Term Comparisons with Pre-Test Behaviour,” International Journal of Epidemiology, Vol. 38, No. 4, 2009, pp. 997-1007.
M. Grossman and S. Markowitz, “I Did What Last Night?! Adolescent Risky Sexual Behaviors and Substance Use,” Eastern Economic Journal, Vol. 31, No. 3, 2005, pp. 383- 405.
M. L. Cooper, “Alcohol Use and Risky Sexual Behavior among College Students and Youth: Evaluating the Evidence,” Journal of studies on alcohol, Vol. 14, No. 1, 2002, pp. 101-117.
M. Coffee and M. N. Lurie, “Garnett GP. Modeling the Impact of Migration on the HIV Epidemic in South Africa,” AIDS, Vol. 21, No. 3, 2007, pp. 343-350. doi:10.1097/QAD.0b013e328011dac9
Y. Berhan, D. Hailu and A. Alano, “Predictors of Risky Sexual Behaviour and Preventive Practices among University Students, Ethiopia,” African Journal of Aids Research, Vol. 10, No. 3, 2011, pp. 225-234. doi:10.2989/16085906.2011.626290
UNAIDS, “Acting Early to Prevent AIDS: The Case of Senegal,” 1999. data.unaids.org/publications/irc-pub04/una99-34_en.pdf
L. D. E. Ikamari, “The Effect of Education on the Timing of Marriage in Kenya,” Demographic Research, Vol. 12, No. 1, 2005, pp. 1-28. doi:10.4054/DemRes.2005.12.1
T. Adair, “HIV Status and Age at First Marriage among Women in Cameroon,” United States Agency for International Development, 2007. pdf.usaid.gov/pdf_docs/PNADI793
J. Bongaarts, “Late Marriage and the HIV Epidemic in sub-Saharan Africa,” The Population Council, 2006. www.popcouncil.org/pdfs/wp/216.pdf
J. G. Fortson, “The Gradient in Sub-Saharan Africa: Socio-Economic Status and HIV/AIDS,” Demography, Vol. 45, No. 2, 2008, pp. 303-322. doi:10.1353/dem.0.0006