The HIV/AIDS epidemic is argued to be one of the greatest health challenges facing Sub-Saharan African countries, with more than 25 million Africans currently infected. Social epidemiology posits that for most types of illness, there is an inverse relationship between indicators with SES. In most developed nations, and in some developing countries, the incidence of HIV follows this classic pattern, with the poor having the greatest risk of infection and eventual mortality. However, a growing body of research on HIV in Sub-Saharan Africa suggests an intriguing reversal of this pattern, particularly with respect to HIV among women. In the Cameroonian case most specifically, previous research indicates that higher socioeconomic status women present higher rates of HIV infection compared to low socioeconomic status women, albeit rates higher than those in the United States. However, the mechanisms of risk appear to be distinct for each group. Using data from the 2004 National Demographic and Health Survey (DHS) in Cameroon, this paper explores relationships between the various indicators of socioeconomic status and HIV, as well as estimates and tests a series of multivariate models designed to highlight the distinct causal pathways that put higher SES women at increased risk of HIV.
In general, my results show that women with increased resources had higher rates of HIV, confirming results published elsewhere. Additionally, women with riskier sexual behaviors also presented higher rates of infection. Counterintuitively, however, women with increased knowledge of HIV, more domestic making authority, and access to health care all had higher rates of HIV infection. Multivariate analysis revealed that the mechanisms of risk varied by socioeconomic status. For women in low socioeconomic group, what seemed to increase their risk was relative inequality (i.e. having a partner outside their socioeconomic bracket). Conversely, for women in the high socioeconomic group, their own sexual behavior seemed to account for their higher rates of HIV infection. What the results of this study indicated therefore was that the mechanisms of risk differed by SES and different approaches targeting each sub-group were needed to effectively combat the disease.