Sunday Times (Johannesburg) - June 18, 2006
Futhi Ntshingila

The study, which was presented and debated at the third annual US President's Emergency Plan for Aids Relief meeting in Durban, found that the poorest 20% of the population almost always had a lower HIV prevalence rate than the richest 20%. The author said it should be used to make sure Aids-prevention messages are reaching those who earn the most money.

"Poverty-driven programmes are likely to have limited impact on prevention efforts when the majority of HIV-infected people are the wealthiest, not the poorest," said Vinod Mishra, director of research at ORC Macro, a Maryland-based research company that conducts surveys around the world.

Mishra cited several possible reasons why those with more money have higher HIV prevalence rates. One is that rich people have more partners, "more opportunities to travel, more opportunities for casual sex" and rich men can afford to buy sex, he said. He also said that wealthier men in Africa start having sex at an earlier age than poorer men, though wealthier women start sex later than poorer women.

Several delegates to the conference later took issue with Mishra's conclusions. "Ninety percent of the people in Africa are poor," John Lambert, a British development official, told Mishra after his talk. "The danger is that people could say that Aids affects the wealthy more than the poor people. We worry about that."

Mishra said HIV infections still have a much harsher impact on the poorest because they generally lack access to good healthcare and nutrition. But he said that many donors and African countries remain dismissive of data that shows the richest men and women in Africa have higher infection rates.

He said that Lambert was partly correct in saying that in many African countries the richest 20% included people who were poor by first-world standards. Still, he said, there was a great divide in African countries between the richest and poorest, and prevention efforts would be better targeted toward those with more wealth.

Standing next to him, Dr Alex Opio, assistant commissioner in Uganda's national Disease Control Department, said he was met with disbelief recently when he briefed foreign donors on the new data. In Uganda, the rate of HIV infection among the poorest 20% of women was 5%, compared with an 11% infection rate for the richest 20%; for men, 4% of the poorest were infected, compared with 6% of the richest.

The data were debated in several corners around the conference, which has attracted more than 1100 delegates. Some raised questions about whether the findings could be extrapolated to the rest of Africa and said this could cause a re-evaluation of whether prevention efforts were adequate.

The surveys, the most complete of their kind in Africa, included interviews with between 6000 and 18000 people in each country and blood samples for HIV tests. Researchers did not ask a person's income level, but instead registered a number of details about a person's house and possessions to rank his or her wealth.

Olive Shisana, chief executive officer of South Africa's Human Sciences Research Council, disputed the findings, saying SA studies had found there was a higher prevalence of HIV among the poor.

"In the general population HIV is far higher in the informal settlements where there is a lot of poverty compared to those in stable housing. The reason is that women who have no resources have no power to negotiate condoms with their partners," she said.

"Last year, the educator's study that was done demonstrated that the educators who were in the low-income category had a higher HIV prevalence compared to those who were in the higher income group."

She said the research may have looked at a country like Botswana with a high GDP and high prevalence of HIV and concluded that the two were related. This was a faulty conclusion, she said.

"It doesn't make sense. Where we did find a high HIV prevalence among people who were doing very well was [when] we looked at marital status.

"There we found that the men who were wealthy had a higher HIV prevalence compared to the women who were wealthy implying that men who had more money were more likely to buy sex." - and

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