Abstract:
Background: Emerging evidence seems to suggest that there is some association
between individual socioeconomic status and sexual risk-taking behaviour in sub-
Saharan Africa. A number of broad associations have emerged, among them,
positive, neutral and negative relationships between wealth status and sexual risktaking
behaviour.
Reduction in the number of sex partners as a behavioural change has been
advocated as an important tool in HIV prevention, and affecting such a change
requires an understanding of some of the factors that can influence social
behaviour, interactions and activities of subpopulations.
Objectives: To further explore the determinants of sexual risk-taking behaviour
(individuals having multiple sex partners), especially the effects that variations in
household wealth status, gender and different subpopulation groups have on this
behaviour.
Methods: The relationship between wealth status and sexual risk-taking behaviour
in the context of HIV/AIDS infection in Ghana and Kenya was assessed
using raw data from the 2003 Demographic and Health Surveys of each country.
Wealth quintiles were used as a proxy for economic status, while non-marital and
non-cohabiting sexual partnerships were considered indicators for risky sexual
behaviour.
Results: For females, there appears to be an increasing probability of sexual risk
taking by wealth status in Kenya, while, in Ghana, an inverted J-shaped relationship
is shown between wealth status and sexual risk taking. When controlled for
other variables, the relationship between wealth status and sexual risk-taking
behaviour disappears for females in the two countries. For males, there is no
clearly discernable pattern between wealth status and sexual risk-taking behaviour
in Ghana, while there is a general trend towards increasing sexual risk-taking
behaviour by wealth status in Kenya. For Ghana, the highest probabilities are
among the highest and the middle wealth quintiles; in Kenya, high probabilities
were found for the two highest wealth quintiles. Controlling for the effects of other factors, the pattern for Ghana is further blurred (not statistically significant),
but the relationship continues to show in the case of Kenya, and is significant for
the highest quintile. In general, for both Ghana and Kenya, men in the highest
wealth quintile were found to be more likely to have multiple sexual partners than
the other groups.
Conclusion: The changing phases of HIV infection indicate that it is no longer
poverty that drives the epidemic. Rather, it is wealth and a number of other
sociodemographic factors that explain sexual risk-taking behaviour that puts
people at risk. Understanding local specific factors that predispose individuals
towards sexual risk taking could help to expand the range of information and
services needed to combat the HIV pandemic.
