Examining the association between HIV prevalence and socioeconomic factors among young people in Zambia: Do neighbourhood contextual effects play a role?

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Abstract Background: Evidently, socioeconomic factors are strongly associated with HIV infection, however, the pattern of association varies. Understanding how these factors influence HIV infection can help public health authorities design targeted comprehensive prevention strategies. Methods: We used multi-level logistic regression models to examine the association of individual and neighbourhood level variables on HIV prevalence based on data from the 2013-14 Zambia Demographic and Health Survey, a population-based cross-sectional survey. The analysis was restricted to young people (15–24 years) with HIV serostatus results (n= 11,751). HIV serostatus was the outcome variable and socioeconomic status was measured by wealth, education and employment.Results: Overall, at individual level, an additional year of education was associated with 5% and 2% reduced odds of infection among young women and men, respectively. Conversely, relative wealth and employment were associated with increased odds of infection among women, while among men the socioeconomic factors were associated with reduced odds of HIV infection. Living in neighbourhoods with medium proportion employed residents and neighbourhoods with higher average level of education were associated with a tendency of higher odds of HIV infection. Thirty percent and 9% of the variation in HIV infection among young men and women, was attributed to neighbourhoods. Inclusion of individual variables to the intercept-only model accounted for 34.9% and 58.1% of the variance for men and women, and reduced the unexplained variance by an average of 17%. However, adding neighbourhood variables to the intercept-only model explained a relatively small part of the variance (0.04 for men and 0.06 for women), and adding the cluster variables to the individual variables only lead to a slight increase in R-squared (explained variance) (36.2% and 58.4%).Conclusion: Our study shows that individual-level socioeconomic factors are clearly associated with young people’s vulnerability to HIV infection in Zambia and that community level factors are less important than previous studies in selected areas of Zambia have indicated. However, the high neighbourhood variation among men, which was mostly unexplained, indicates that there are dynamics within communities, possibly affecting the way people interrelate, that can put them at increased risk.

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