The Risks of Social Advancement (for Women)

The notion that poverty and disease are closely linked underlies almost every conversation about global health, and it has become axiomatic in the sector that both conditions form a part of what has often been described as a vicious circle. In fact, there is ample evidence that this bidirectional relationship is strong, but occasionally some unexpected data emerges that makes us take another look at the facts.

Clearly HIV/AIDS is a disease that leads to poverty if the patient has no access to the necessary care, as is still the case in many parts of Africa. The affected person—usually of working age—is unable to work and a family member must abandon his or her own job or studies to care for the patient. What is less clear is whether poverty per se is a risk factor for contracting HIV infection.

A trickle of studies carried out in various African countries over several years, summarized by Gillespie and colleagues in 2007, showed no clear correlation between poverty and the risk of HIV infection. In fact, particularly in the case of women, it may be easier to argue that the opposite is true: the results of research tended to indicate a positive association between higher socioeconomic status and HIV infection. An association can also be demonstrated between HIV infection and economic migration, a step usually undertaken to improve the emigrant’s economic situation. By contrast, no link has been found between such infection and a higher educational level, which used to be a protective factor.

Later research in Tanzania, published in 2008, reported similar results: the higher a woman’s socioeconomic status, the greater her risk of HIV infection. In this case, as in the other studies, even a higher educational level did not offset the risk. A more recent study, published in 2011 as a doctorate thesis, established an association between risk of HIV and income level among a group of women in Cameroon and, furthermore, demonstrated a positive association with degree of access to the health system, power over household decisions and, against all expectations, level of knowledge about HIV.

Sometimes, thinking outside the box can bring us closer to reality than simply settling for a generally accepted axiom.