Extreme climate, droughts may influence increase in HIV: study

Women in rural areas which have recently experienced drought have increased odds of being infected with HIV in sub-Saharan Africa as they are also more likely to be living in poverty.

This is according to the research study “Investigating the Associations between Drought, Poverty, High-Risk Sexual Behaviours and HIV Incidence in sub-Saharan Africa: A Cross-Sectional Study” by Adam Trickey published in the journal Aids and Behavior.

According to the paper, extreme weather events such as droughts cause decreased food yields which impact negatively on human health, increasing poverty and food insecurity, and worsening the structural problems underlying HIV transmission, particularly among women.

“This can be through changes in sexual behaviours driven by poverty, such as increased transactional sex, which is also linked to intergenerational sex, particularly where young women partner with older men who have more resources and higher HIV prevalence.

“Women in these circumstances may have less say in the use of contraception, increasing condomless sex with casual partners,” it says.

The research team combined data from five nationally representative surveys of more than 100,000 adults aged 15-59 that were carried out in 2016 in Eswatini, Lesotho, Tanzania, Uganda and Zambia.

“Drought has been hypothesised to affect HIV acquisition through an increase in gender-based violence and worsening mental health which can impact sexual behaviours and access to HIV prevention services. Women in rural areas who had been exposed to drought had higher odds of having recently acquired HIV but not women in urban areas, or men.

“The relationships between poverty and HIV in sub-Saharan Africa are nuanced and debated. At a global level, HIV is thought to disproportionately affect poorer individuals, while in sub-Saharan Africa the relationship between poverty and HIV differs between urban and rural areas.

“More research is required on the mechanisms by which poverty affects HIV and, additionally, on the associations connecting drought with HIV via poverty.”

Behavioural patterns differed by levels of poverty, with associations identified between poverty and self-reported recent sexual behaviours.

“There was weak evidence of a positive association between increasing wealth and high-risk sex among women in rural areas, while there was stronger evidence of a positive association among rural men, but the opposite pattern among urban men.

“There were increased odds of having recently acquired HIV among women in rural areas reporting high-risk sex, and women in urban areas reporting high-risk sex or intergenerational sex, with no strong associations observed among men.”

The research recommended that interventions that could mitigate the effect of drought on HIV transmission should be considered.

“Future research should use longitudinal data to elucidate the temporal and causal associations for the pathway linking drought with increased HIV transmission.”

However, Russell Rensburg, executive director of the Rural Health Advocacy Project, said the research must be taken with a pinch of salt as “it is too soon to tell”.

“They are inferring droughts lead to increased economic vulnerability, which in turn could lead to increased risky sex and an increase in HIV infection. [But] it doesn’t consider increased coverage of people on antiretrovirals which reduce viral load and minimise the risk of transmission,” he said.

“We are only beginning to work on the possible impact of climate change on health so I would be cautious [about making inferences at this stage].”

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