Place Matters : Multilevel Investigation of HIV Distribution in Tanzania

Place Matters : Multilevel Investigation of HIV Distribution in Tanzania

OBJECTIVE: To examine the extent to which the regional and neighborhood distribution of HIV in Tanzania is caused by the differential distribution of individual correlates and risk factors. METHODS: Nationally representative, cross-sectional data on 12,522 women and men aged 15-49 years from the 200...

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Main Authors: Msisha, W. M., Kapiga, S. H., Earls, F. J., Subramanian, S. V.
Format: Journal Article
Language:EN
Published: 2012
Subjects:
Adolescent
Adult
Cross-Sectional Studies
Developing Countries
Female
HIV Seroprevalence
Hiv-1
Health Surveys
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Poverty
Residence Characteristics
Risk Factors
Rural Population
Tanzania
Medical Topography
Urban Population
Online Access:http://hdl.handle.net/10986/5113
id okr-10986-5113
recordtype oai_dc
spelling okr-10986-51132021-04-23T14:02:21Z Place Matters : Multilevel Investigation of HIV Distribution in Tanzania Msisha, W. M. Kapiga, S. H. Earls, F. J. Subramanian, S. V. Adolescent Adult Cross-Sectional Studies Developing Countries Female HIV Seroprevalence Hiv-1 Health Surveys Humans Incidence Male Middle Aged Multivariate Analysis Odds Ratio Poverty Residence Characteristics Risk Factors Rural Population Tanzania Medical Topography Urban Population OBJECTIVE: To examine the extent to which the regional and neighborhood distribution of HIV in Tanzania is caused by the differential distribution of individual correlates and risk factors. METHODS: Nationally representative, cross-sectional data on 12,522 women and men aged 15-49 years from the 2003-2004 Tanzanian AIDS Indicator Survey. Three-level multilevel binary logistic regression models were specified to estimate the relative contribution of regions and neighborhoods to the variation in HIV seroprevalence. RESULTS: Spatial distribution of individual correlates (and risk factors) of HIV do not explain the neighborhood and regional variation in HIV seroprevalence. Neighborhoods and regions accounted for approximately 14 and 6% of the total variation in HIV. HIV prevalence ranged from 1.8% (Kigoma) to 6.7% (Iringa) even after adjusting for the compositional make-up of these regions. An inverse association was observed between log odds of being HIV positive and neighborhood poverty [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09-0.61] and regional poverty (OR 0.97, 95% CI 0.95-0.99). CONCLUSION: Our study provides evidence for independent contextual variations in HIV, above and beyond that which can be ascribed to geographical variations in individual-level correlates and risk factors. We emphasize the need to adopt both a group-based and a place-based approach, as opposed to the dominant high-risk group approach, for understanding the epidemiology of HIV as well as for developing HIV intervention activities. 2012-03-30T07:31:21Z 2012-03-30T07:31:21Z 2008 Journal Article AIDS 1473-5571 (Electronic) 0269-9370 (Linking) http://hdl.handle.net/10986/5113 EN http://creativecommons.org/licenses/by-nc-nd/3.0/igo World Bank Journal Article Tanzania
repository_type Digital Repository
institution_category Foreign Institution
institution Digital Repositories
building World Bank Open Knowledge Repository
collection World Bank
language EN
topic Adolescent
Adult
Cross-Sectional Studies
Developing Countries
Female
HIV Seroprevalence
Hiv-1
Health Surveys
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Poverty
Residence Characteristics
Risk Factors
Rural Population
Tanzania
Medical Topography
Urban Population
spellingShingle Adolescent
Adult
Cross-Sectional Studies
Developing Countries
Female
HIV Seroprevalence
Hiv-1
Health Surveys
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Poverty
Residence Characteristics
Risk Factors
Rural Population
Tanzania
Medical Topography
Urban Population
Msisha, W. M.
Kapiga, S. H.
Earls, F. J.
Subramanian, S. V.
Place Matters : Multilevel Investigation of HIV Distribution in Tanzania
geographic_facet Tanzania
relation http://creativecommons.org/licenses/by-nc-nd/3.0/igo
description OBJECTIVE: To examine the extent to which the regional and neighborhood distribution of HIV in Tanzania is caused by the differential distribution of individual correlates and risk factors. METHODS: Nationally representative, cross-sectional data on 12,522 women and men aged 15-49 years from the 2003-2004 Tanzanian AIDS Indicator Survey. Three-level multilevel binary logistic regression models were specified to estimate the relative contribution of regions and neighborhoods to the variation in HIV seroprevalence. RESULTS: Spatial distribution of individual correlates (and risk factors) of HIV do not explain the neighborhood and regional variation in HIV seroprevalence. Neighborhoods and regions accounted for approximately 14 and 6% of the total variation in HIV. HIV prevalence ranged from 1.8% (Kigoma) to 6.7% (Iringa) even after adjusting for the compositional make-up of these regions. An inverse association was observed between log odds of being HIV positive and neighborhood poverty [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09-0.61] and regional poverty (OR 0.97, 95% CI 0.95-0.99). CONCLUSION: Our study provides evidence for independent contextual variations in HIV, above and beyond that which can be ascribed to geographical variations in individual-level correlates and risk factors. We emphasize the need to adopt both a group-based and a place-based approach, as opposed to the dominant high-risk group approach, for understanding the epidemiology of HIV as well as for developing HIV intervention activities.
format Journal Article
author Msisha, W. M.
Kapiga, S. H.
Earls, F. J.
Subramanian, S. V.
author_facet Msisha, W. M.
Kapiga, S. H.
Earls, F. J.
Subramanian, S. V.
author_sort Msisha, W. M.
title Place Matters : Multilevel Investigation of HIV Distribution in Tanzania
title_short Place Matters : Multilevel Investigation of HIV Distribution in Tanzania
title_full Place Matters : Multilevel Investigation of HIV Distribution in Tanzania
title_fullStr Place Matters : Multilevel Investigation of HIV Distribution in Tanzania
title_full_unstemmed Place Matters : Multilevel Investigation of HIV Distribution in Tanzania
title_sort place matters : multilevel investigation of hiv distribution in tanzania
publishDate 2012
url http://hdl.handle.net/10986/5113
_version_ 1764393999535177728

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