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Vulnerability and risk to HIV infection in Uganda: multilevel modelling of Uganda AIDS Indicator Survey Data

Igulot, P. (2017). Vulnerability and risk to HIV infection in Uganda: multilevel modelling of Uganda AIDS Indicator Survey Data. (Unpublished Doctoral thesis, City, University of London)



HIV/AIDS continues to be a global problem; by 2013, there were 35.3 million people infected globally. Sub Saharan Africa (SSA) continues to be disproportionately affected with 70 percent of all cases, 73 percent all deaths, and 70 percent of all new infections. Although some progress has been made in the response to the epidemic, major challenges remain. For example, even though new infections have been declining in some countries, these are being offset by increases in others. Uganda is one of the countries where HIV infection rates have been increasing in the last 15 years, from 6.2 percent in 2000 to 6.4 percent in 2005 to 7.3 percent in 2012. Much as SSA is disproportionately affected by HIV/AIDS, the region has received considerable research attention, including the association between HIV/AIDS and socioeconomic status (SES) and sexual and gender based violence (SGBV). However, there continues to be controversy surrounding the effect of SES and SGBV on the vulnerability of individuals to the risk of HIV infection.

Aims and research questions

To contribute to the above debates, this research utilises Bourdieu’s Socio-Structural Theory of Practice (STOP) which argues that individuals are born into a field, which structures their habitus or world view but the field in turn is structured by habitus. To operationalize this theory, this research answers the following broad question, what is the influence of social factors on vulnerability and risk to HIV infection in Uganda? And the following specific questions: (1) what is the effect of SES (wealth status & educational attainment) on people’s vulnerability to the risk of HIV infection in Uganda? (2) What is the effect of SGBV on vulnerability to the risk of HIV infection in Uganda? And, (3) what are the effects of social and structural factors on vulnerability to the risk of HIV infection in Uganda?

Data and methods

This research was based on a nationally representative sample of 22,979 women and 18,418 men of reproductive age from 20,869 households with 33,692 rural and 7,705 urban respondents in Uganda. The analyses were based on the application of Multilevel Logistic regression models to 2004-05 and 2011 Uganda AIDS Indicator Surveys, fitted in MLwiN. Chapter 5 about the influence of SES on HIV infection and Chapter 6 on the influence of community factors on HIV infection are based on pooled data of 2004–05 and 2011 surveys but Chapter 7 on the influence of SGBV on HIV infection is based on only the 2011 data.

Key findings

The results provide little evidence of a significant overall association between household wealth and HIV infection. However, there is some indication of increased risk among those in wealthier households that is explained by sexual behavior factors. The increased vulnerability of individuals in wealthier households is particularly apparent for women and rural residents. On the other hand, individuals with higher educational attainment have reduced odds of HIV infection. Those with secondary or higher educational attainment have 37 percent lower odds of being HIV-positive compared to those with no education in the general population when other socio-economic, socio-demographic, and socio-sexual factors are controlled for, and secondary or higher education is more effective in reducing vulnerability in urban than rural areas, and in 2011 than 2004–05. However, incomplete or complete primary educational attainment is associated with increased odds of being HIV-positive in both 2004/5 and 2011 and among rural residents, when important socio-demographic and sexual behavior factors are controlled for. Sexual and gender based violence is associated with increased vulnerability to HIV infection by 34 percent at the individual-level.

Besides individual-level effects, community-level SES and SGBV are also important determinants of HIV vulnerability. When both community and individual-level factors were controlled for, living in a community with a higher proportion of wealthy households was associated with increased likelihood of being infected with HIV compared to living in communities with a lower proportion of wealthy households. For social factors, living in an area with higher proportions of: formerly married people, and people who were drunk with alcohol before unsafe sex was also associated with an increased likelihood of being infected with HIV compared to living in areas with lower proportions of people with these practices who had similar other characteristics. However, living in communities with a higher proportion of polygamous men was associated with a lower likelihood of being infected with HIV compared to living in communities with a lower proportion of polygamous men. Overall, community factors account for 10 percent of total variation in HIV prevalence.

Conclusions and policy implications

Individual-level and societal factors are both important in creating vulnerability to the risk of HIV infection in Uganda. These conclusions are largely consistent with Bourdieu’s theoretical and methodological principles and have broad implications for the HIV/AIDS response that presently pays less attention to societal determinants of HIV vulnerability. To effectively prevent HIV infections, HIV/AIDS policies need to recognize the micro, macro, and complex nature of the AIDS epidemic in Uganda. Attention needs to be paid to how household and community wealth, educational attainment and SGBV influence vulnerability to the risk of HIV infection in Uganda and perhaps, similar settings elsewhere.

Publication Type: Thesis (Doctoral)
Subjects: H Social Sciences > HM Sociology
Departments: School of Policy & Global Affairs > Sociology & Criminology
Doctoral Theses
Doctoral Theses > School of Arts and Social Sciences Doctoral Theses
School of Policy & Global Affairs > School of Policy & Global Affairs Doctoral Theses
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