However, other researchers in the field see the relationship between poverty and HIV as a much more complex one. In their recently published AIDS in the Twenty-First Century Professors Tony Barnett and Alan Whiteside of the London School of Economics and the University of Kwazulu-Natal note that income status has a limited ability to predict an individual’s risk of HIV infection independent of the social setting in which they exist.
In their opinion, the most important reason for focusing on the relationship between poverty and HIV is in order to understand they way in which impoverishment of a whole continent has led to the exceptionally severe epidemic experienced in sub-Saharan Africa.
Data from studies in South Africa also suggest that wealth is not a significant ‘contributor’ to HIV prevalence there — even among the black population (Kalichman 2006). Rather, in a study presented at the 2nd South African AIDS Conference, individual risk factors such as older age, early sexual debut and multiple lifetime partners were associated with higher HIV risk, but so were structural factors related to the community (Pronyk).
These included easier access to a trading centre (p=0.02), higher proportions of short-term residents (p=<0.001), and lower levels of social capital (p<0.001 men, p=0.02 women), an index based on social network membership and responses to questions on: levels of trust, reciprocity, solidarity in time of crisis, collective action (positive (marches/rallies) and negative (local serious and violent crime rate). In other words, HIV prevalence was higher in settings where the social order had broken down (or had never been established in the first place).
Among men, higher HIV prevalence was also seen among communities with easier access to a local mine (p=0.05), a higher density and activity of local bars (p=0.004), a higher numbers of sex workers per village (p=<0.001), and lower proportions of out-migrants (p=0.002).
Although, Dr. Mishra investigated some of these questions, he did not explore such concepts as social capital and societal structure, which may be necessary to better understand the reasons for risky behaviour. But it may also be that the southern African epidemic is different from what is being observed in the other countries in Dr. Mishra’s survey, due in part to biological factors such as HIV-1 subtype.
In addition, a limitation of the survey is that it only describes prevalence and current socioeconomic status — it does not explore transitional relationships, including the individual’s socioeconomic status at the point of infection, or possibly more importantly, earlier in life. It is quite possible, even likely, that the most destitute people in agrarian Africa may have fewer opportunities to become infected.
However, as Dr. Mishra noted, the relationships between poverty and HIV may be transitional. By definition, poverty coping mechanisms should have the benefit of getting one out of the most desperate poverty. Poverty is a major factor driving people to leave the rural or village setting for the greater economic activities that exist in urban areas. Poverty drives men to migrate for labour to work in the mines or factories, or to become long distance truck drivers — which increases their personal and household wealth while pulling them away from their family and increasing their likelihood of engaging in risky sexual behaviour.
Poverty has been shown to drive women into commercial sex work, which clearly increases HIV risk. Likewise, some women may accept concurrent partners because it has economic benefits to them, or young girls may accept sugar daddies to improve their financial standings and options for a future. These risk takers in African society may wind up better off financially but at a cost of increased HIV risk. And this survey only has limited capacity to explore such questions.