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Title What explains gender inequalities in HIV/AIDS prevalence in sub-Saharan Africa? Evidence from the demographic and health surveys.

Full text https://escholarship.org/uc/item/7x64064m

Date 2016

Author(s) Sia, Drissa; Onadja, Yentéma; Hajizadeh, Mohammad; Nandi, Arijit; Heymann, Sally; Brewer, Timothy

Abstract BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

Subject(s) Blinder-Oaxaca decomposition; Gender inequality; HIV/AIDS; Sub-Saharan Africa; Adolescent; Adult; Africa South of the Sahara; Cameroon; Eswatini; Female; Ghana; HIV Infections; Health Status Disparities; Health Surveys; Humans; Malawi; Male; Middle Aged; Prevalence; Risk Factors; Sex Distribution; Sex Factors; Sexual Behavior; Uganda

Publisher eScholarship, University of California

Type of publication article

Format application/pdf

Source BMC Public Health, vol 16, iss 1

Rights public

Identifier qt7x64064m

Repository Berkeley - University of California

Added to C-A: 2024-01-08;10:38:22

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