Inequality drives the HIV epidemic

HIV and poverty go hand in hand. Poor countries have a higher prevalence of infection, and the poorest people in those countries are disproportionately affected. Poverty is part of the cause of HIV and is also its inevitable result. A closer look at the economic reality of HIV, however, suggests that inequality—not just poverty—is the dominant driving force behind the epidemic, say experts from the Joint United Nations Programme on HIV/AIDS.

In sub-Saharan Africa, countries with the most unequal distribution of wealth such as Botswana, Namibia, and South Africa have the highest prevalence of HIV. Inequality between the sexes is also important. Women who are financially dependent on men have little power to negotiate safe sex. The link goes beyond the purely economic to marginalised groups such as drug users and migrants who have unequal access to social benefits and human rights, say the experts.

Controlling the spread of HIV will be a lot more complicated than alleviating poverty, which is complicated enough. Economic development may even fuel the epidemic by exacerbating inequality. Projects to reduce poverty and encourage development must be aimed at the poorest, be aware of HIV, and be tailored to the conditions, particularly the inequalities, operating locally.