HIV / STI
Regional and socioeconomic disparities in HIV prevalence among reproductive-aged women in The Gambia: an analysis of national survey Amadou Barrow* Amadou Barrow Dr Yan Wang
Background: Human Immunodeficiency Virus (HIV) infection is a major public health issue in The Gambia with a higher prevalence among women. Regional and socioeconomic disparities in HIV epidemiology have not been well studied in developing countries. Understanding the variations and determinants of HIV infection is important for tailoring responses, particularly in rural areas. This study analyzed the regional and socioeconomic disparities in HIV prevalence among women of reproductive age.
Methods: We analyzed data from 4487 reproductive-aged women in the 2013 Gambia Demographic and Health Survey (GDHS) using bivariate analyses and multilevel regression to estimate adjusted prevalence ratios (aPR) for associations between HIV infection and regional, sociodemographic, sexual history, and healthcare factors. The Lorenz curve, concentration index, slope, and relative indices of inequality for HIV prevalence were used to analyze socioeconomic disparities. Statistical significance was set at 5.
Results: The HIV-weighted prevalence was 2.1% (urban: 2.4%; rural: 1.8%). After controlling for confounders, rural residence (aPR=0.50, 95% CI: 0.26, 0.97), ages 35-39 years (aPR=5.03, 95% CI: 1.45, 17.51), richest household wealth (aPR=0.33, 95% CI: 0.12, 0.94), and ≥2 lifetime partners (aPR=3.31, 95% CI: 2.01, 5.44) were identified. Significant pro-rich disparities existed for maternal age, 6.7 times higher (95% CI: 3.8, 9.9) relative HIV prevalence for lowest versus highest position; pro-poor disparities for maternal education, 53% lower (95% CI: 0.23, 0.71) relative prevalence for lowest versus highest position. Significant inequalities in pro-poor HIV prevalence for ≥2 lifetime partners by household wealth (Conc. index=-0.069, SE=0.024), and education (Conc. index =-0.054, SE=0.020); no recent STIs (Conc. index =-0.013, SE=0.004) and no insurance (Conc. index =-0.012, SE=0.043) and recent sexual activity (Conc. index =-0.010, SE=005) by education.
Conclusions: Marked regional and sociodemographic HIV disparities exist among Gambian women. Targeting higher-risk women in urban settings, middle age groups, lowest wealth quintiles, and those with multiple partners could help address population-level socioeconomic HIV inequalities.