The Role of Structural Factors in HIV Transmission in Uganda
Nnyanzi, David. “The Role of Structural Factors in HIV Transmission in Uganda”. PhD, Boston College, 2011. http://hdl.handle.net/2345/2365.
Since the early 1980s, Uganda has been in the spotlight of global concerns about the HIV/AIDS epidemic that has almost brought the country to its knees. Consequently, a number of social epidemiologists and researchers from different social science fields have, over the past two and half decades, focused their attention on Uganda, attempting to identify the risk factors that expose people to HIV infection in order to inform intervention policy. Although studies coming out of this effort have provided important insights into risks of HIV infection, they have been criticized for almost entirely focusing on individual behavioral factors, such as prostitution and inconsistent condom use, as the primary causal factors of HIV infection, without comprehending the contextual background in which HIV infection takes place. Using the 2000/01 Uganda Demographic and Health Survey and employing multilevel logistic regression methods, I address this concern by investigating the influence of contextual factors on three behaviors related to the risk of HIV infection (HIV testing, multiple sexual partnering, and inconsistent condom use). Analyses reveal that educational attainment, socioeconomic status, and religion significantly predict HIV testing, multiple sexual partnering, and condom use for both men and women - and at both the individual and neighborhood levels. Analyses also reveal that age has an inverted U-shaped association with HIV testing and multiple sexual partnering for both men and women at the individual level. Despite important gains in slowing HIV infection rates over the past two decades, Uganda's increasing burden of the HIV/AIDS epidemic - amid faltering healthcare and other social services investments - is inevitable. It is apparent that there are formidable obstacles to effectively eradicating HIV/AIDS, unless essential social services - such as education, accessible healthcare services - are enhanced, and policies are introduced to improve socioeconomic status of individuals and entire neighborhoods.