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Type: Journal article
Title: Global income-related inequalities in HIV testing
Author: Larose, A.
Moore, S.
Harper, S.
Lynch, J.
Citation: Journal of Public Health (Print Edition), 2011; 33(3):345-352
Publisher: Oxford University Press
Issue Date: 2011
ISSN: 1741-3842
Statement of
Auburn Larose, Spencer Moore, Sam Harper and John Lynch
Abstract: BACKGROUND: Voluntary counseling and testing (VCT) is an important prevention initiative in reducing HIV/AIDS transmission. Despite current global prevention efforts, many low- and middle-income countries continue reporting low VCT levels. Little is known about the association of within- and between-country socioeconomic inequalities and VCT. Based on the ‘inverse equity hypothesis,’ this study examines the degree to which low socioeconomic groups in developing countries are disadvantaged in VCT. METHODS: Using recently released data from the 2002 to 2003 World Health Survey (WHS) for 106 705 individuals in 49 countries, this study used multilevel logistic regression to examine the association of individual- and national-level factors with VCT, and whether national economic development moderated the association between individual income and VCT. Individual income was based on country-specific income quintiles. National economic development was based on national gross domestic product per capita (GDP/c). Effect modification was evaluated with the likelihood ratio test (G2). Individuals eligible for the VCT question of the WHS were adults between the ages of 18–49 years; women who had given birth in the last 2 years were excluded from this question. RESULTS: VCTwas more likely among higher income quintiles and in countries with higher GDP/c. GDP/c moderated the association between individual income and VCT whereby relative income differences in VCTwere greater in countries with lower GDP/c (G2¼ 9.21; P ¼ 0.002). Individual socio-demographic characteristics were also associated with the likelihood of a person having VCT. CONCLUSIONS: Relative socioeconomic inequalities in VCT coverage appear to decline when higher SES groups reach a certain level of coverage. These findings suggest that changes to international VCT programs may be necessary to moderate the relative VCT differences between highand low-income individuals in lower GDP/c nations.
Keywords: HIV; inequalities; socioeconomic factors; World Health
Rights: © The Author 2011, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
RMID: 0020117781
DOI: 10.1093/pubmed/fdr001
Appears in Collections:Public Health publications

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