Poor livelihood opportunities help to shape patterns of sexual mixing and deplete hope, self-efficacy and trust. This – together with associated migration – can foster risky behaviour and hinder HIV prevention and treatment efforts.
Rich and poor
HIV can affect both wealthy and poor groups. But different structural factors shape HIV risks for the poor and the rich. In STRIVE’s focus countries, evidence indicates that the next 1,000 HIV infections will disproportionally affect relatively marginalised populations.
- In India the epidemic is concentrated among socially marginalised, high-risk groups such as sex workers, men who have sex with men and IV drug users.
- In Tanzania, national level data showed higher HIV prevalence in wealthier groups, but this pattern is shifting over time: prevalence is rising or stable among the poorest, least-educated women, while falling in wealthier men and women.
- In South Africa, earlier infections hit higher socio-economic groups, but new ones are rapidly concentrating among the poor.
In many settings, employment is limited and poorly paid. Levels of unemployment and out-migration are high. For men, these conditions:
- promote fatalism,
- undermine initiative,
- encourage excessive alcohol use, and therefore
- block the success of HIV prevention efforts.
Opportunities for women are even more constrained. These conditions:
- foster dependency on men for resources,
- promote exchange of sex for food, money or gifts and
- undermine a sense of agency and action.
Control over income and economic assets, such as housing and land, can protect women from violence and destitution, thereby reducing their vulnerability to HIV.