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Socio-economic inequity in HIV testing in Malawi

Skordis-Worrall, J; Kim, SW; Haghparast-Bidgoli, H; Pulkki-Brannstrom, AM; (2016) Socio-economic inequity in HIV testing in Malawi. Global Health Action , 9 (1) , Article 31730. 10.3402/gha.v9.31730. Green open access

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BACKGROUND: HIV (Human Immunodeficiency Virus) is a significant contributor to Malawi’s burden of disease. Despite a number of studies describing socioeconomic differences in HIV prevalence, there is a paucity of evidence on socioeconomic inequity in HIV testing in Malawi. OBJECTIVE: To assess horizontal inequity (HI) in HIV testing in Malawi. METHODS: Data from the Demographic and Health Surveys (DHS) 2004 and 2010 in Malawi are used for the analysis. The sample size for DHS 2004 was 14,571 (women=11,362, men=3,209) and 29,830 for DHS 2010 (women=22,716 and men=7,114). The concentration index is used to quantify the amount of socioeconomic related inequality in HIV testing. The inequality is corrected for need using a decomposition method. Horizontal inequity (standard) is compared with need-adjusted inequity. Variables used to measure health need include symptoms of sexually transmitted infections. Non-need variables include wealth, education, literacy, and marriage status. RESULTS: Between 2004 and 2010 the proportion of the population ever tested for HIV increased from 15% among women and 16% among men, to 75% among women and 54% among men. The need for HIV testing among men was concentrated among the relatively wealthy in 2004, but need was more equitably distributed in 2010. Standard HI was 0.152 in 2004 and 0.008 in 2010 among women, and 0.186 in 2004 and 0.04 in 2010 among men. Rural-urban inequity also fell in this period, but HIV testing remained pro-rich among rural men (HI 0.041). The main social contributors to inequity in HIV testing were wealth in 2004 and education in 2010. CONCLUSIONS: Inequity in HIV testing in Malawi decreased between 2004 and 2010. This may be due to the increased support to HIV testing by global donors over this period.

Type: Article
Title: Socio-economic inequity in HIV testing in Malawi
Open access status: An open access version is available from UCL Discovery
DOI: 10.3402/gha.v9.31730
Publisher version: http://dx.doi.org/10.3402/gha.v9.31730
Language: English
Additional information: Copyright © 2016 Sung Wook Kim et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
Keywords: Inequity, decomposition analysis, HIV testing, socioeconomic status, Malawi
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/1519900
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