| 5. Does Poverty Increase the Likelihood of HIV Infection |
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The relationship of HIV/AIDS to poverty has received prominence in South Africa recently because of the public stance taken by President Mbeki that poverty causes AIDS. Unfortunately, this simple statement of causation has sown confusion and created controversy because whilst there is a partial truth in the statement it is far from being the whole truth.
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The partial truth is that poverty makes people more vulnerable to becoming infected with HIV but poverty does not cause AIDS any more than poverty causes TB, leprosy or any other infective condition. This vulnerability, however, is important because it increases the probability of transmitting or becoming infected with HIV.
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The pathways by which poverty and income inequalities increases an individual's chances of transmitting or acquiring HIV are numerous. For example, poor people may have less access to information about how to protect themselves and may have less access to protective measures such as condoms. Poor people also have less access to high quality health care that reduces their chances of being cured of sexually transmitted diseases. Poverty also drives people to engage in high-risk activities such as survival sex or commercial sex work and our own research with sex workers from the local truck stops has found that clients are prepared to pay more for sex without condoms.
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However, having personal wealth is by no means protective against contracting HIV and factors such as having excess disposable income and frequent travelling put such people at high risk for HIV. The difference between the poor and the wealthy is that the latter are in a stronger position to modify their behaviour than the former. It is for this reason that the distribution of HIV, whether in Ethiopia, Brazil or the US, tends to move from the elite to the poorer communities.
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Evidence for this comes from comparing early studies in Africa which showed that there was a positive association between HIV and socio-economic status and more recent studies. In a study conducted by the author on over 5 000 individuals employed by a large parastatal corporation in South Africa, the HIV prevalence among unskilled workers was 14.7% compared to 3.3% among management (whilst controlling for race) (Colvin, 2000).
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Therefore, whilst there is little direct proof that there is a strong relationship between poverty and HIV/AIDS, it can be concluded from data on the changing distribution of HIV/AIDS that poorer people are more vulnerable to becoming infected.
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