Wealth, wealth indices and HIV risk in East Africa.

Abstract

For nearly two decades the conviction that poverty fuels the spread of HIV in Sub-Saharan Africa has been ubiquitous among epidemiologists and development workers. In 2005 however a team of epidemiologists published a comment in The Lancet drawing attention to some surprising findings: Demographic and Health Survey (DHS) data from Kenya and Tanzania appear to demonstrate that HIV prevalence is highest among the wealthiest segments of those populations and lowest among the poor. In light of these findings the authors suggested that wealth rather than poverty may be the root cause of behavioral risk for HIV in Sub-Saharan Africa. This interpretation of DHS findings depends on the validity of the measurement of wealth. I argue here that the DHS approach to measuring wealth is inconsistent with the complexities of contemporary African livelihoods. As a result the conclusion that wealth fuels the spread of HIV in East Africa may be misleading. (excerpt)