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HIV im südlichen Afrika : eine empirische Untersuchung von HIV Risiko Faktoren
By the end of 2005, 38.6 million people worldwide were infected with HIV. The epidemic is concentrated on Sub Saharan Africa, where HIV prevalence among the adult population (15-49 years) had reached 6.1 percent. Since there is currently no effective cure against AIDS, prevention of new HIV cases is the only way to halt the epidemic. It is unclear however, which prevention methods can effectively reduce HIV incidence since many prevention intervention have been found to be inefficient in reducing the spread of HIV/AIDS in Sub Saharan Africa. This demonstrates the need for further research that serves as entry point for the design of theory and evidence-based HIV prevention interventions.
This thesis provides such research. It theoretically and empirically analyzes sexual behavior, network characteristics and risk factors associated with the spread of HIV in Sub Saharan Africa and discuss their implication for the design of effective HIV prevention strategies.
The thesis discusses the determinants of condom use with special emphasis on individual risk perceptions. This study analyzes condom use in the context of a rational choice framework, where individuals make their decision on condom use based on their perceptions on their own and their partners HIV serostatus. This implies that the perceived risk imposed by a partner as well as the perceptions about the own risk are important determinants of condom use. Using data provided by the Tanzania AIDS Indicator Survey, it is tested whether proxies for the partner’s risk of HIV infection and instruments for perceived risk are significant determinants of condom use. It turns out that, while higher HIV prevalence rates result in a higher propensity to use condoms, perceptions of high infection risk decrease condom use.
Studying the behavior of isolated individuals however, cannot adequately portray the spread of HIV, as the virus spreads within a network of sexual contacts. Therefore, the thesis discusses the structure of complex sexual networks and outlines the implication for the spread of HIV. Data from seven Sub Saharan countries is used to empirically analyze which network type is most suitable to describe the complex structure of sexual networks. Sexual networks appear to be scale-free. These networks are characterized by a considerable heterogeneity in the number of partnerships. They are highly clustered, where few people have a high number of partners and are directly connected with a large part of the remaining network. In such a network, the spread of HIV is highly dependent on the behavior of people with many partners (hubs) and is less reliant on people with a moderate or small number of partners.
Finally, to concentrate on factors associated with the sexual spread of HIV/AIDS in Sub Saharan Africa falls too short to explain the African HIV/AIDS epidemic because a substantial fraction of HIV infections may be attributable to alternative transmission modes, particularly to HIV transmission by unsafe health care. This thesis provides evidence for the importance of iatrogenic HIV transmission in Sub Saharan Africa. Using data from Cameroon and Burkina Faso, the association between health care exposure and HIV serostatus is analyzed. HIV prevalence rates tend to be higher among women who received Tetanus injections during last pregnancy. Empirical evidence for the hypotheses that this association is explained by reverse causality, omitted variables, or self-selection cannot be found. A second analysis uses aggregated data to study the association between health care characteristics and HIV prevalence rates. It is shown that the failure to use auto-disable syringes in the formal health care sector is significantly associated with higher HIV prevalence rates. The empirical findings of this chapter indicate that unsafe health care could be an important factor contributing to Sub Saharan Africa’s HIV/AIDS epidemic.
Bases on these findings, the thesis discusses the implications for the design of effective prevention strategies:
(1) HIV prevention interventions need to consider the economic rational of sexual behavior to set incentives in order to achieve an increase in condom use. This includes interventions that reduce high risk perceptions to reduce fatalistic behavior as well as incentives that decrease the utility difference between protected and unprotected sex.
(2) The characteristics of the complex network structures need to be addressed by targeting HIV prevention at people with many partners. This requires having knowledge about risk-groups which may serve as hubs as well as a better understanding of their needs in order to design interventions that significantly reduce the behavior of people who facilitate the spread of HIV/AIDS.
(3) An important insight from this book is that unsafe health care may impose a risk of HIV transmission. Thus, focusing on preventing sexual transmission may be insufficient and further resources may need to be spent on preventing iatrogenic transmission.
Die Arbeit beschäftigt sich mit der Ausbreitung des Humanen
Immundefizienz-Viruses im südlichen Afrika. Anhand von repräsentativen
Mikrodatensätzen (Demographic and Health Surveys) werden
unterschiedliche Risikofaktoren und Verhaltensfaktoren (wie z.B. die
Verwendung von Kondomen, die Anzahl von Partnern, und der Zugang zu
einem potential unsicheren Gesundheitssektor) empirisch untersucht.
Aus diesen empirischen Ergebnissen werden dann Handlungsvorschläge für
|SWD-Schlagwörter:||HIV-Infektion , AIDS , Prävention|
|Freie Schlagwörter (deutsch):||Kondome , Netzwerke , Gesundheitssystem|
|Freie Schlagwörter (englisch):||condoms , sexual networks , health care systems|
|Institut:||Institut für Allgemeine Wirtschaftsforschung|
|Fakultät:||Wirtschafts- und Verhaltenswissenschaftliche Fakultät|
|Erstgutachter:||Schulze, Günther G. (Prof. Dr.)|
|Tag der mündlichen Prüfung:||12.10.2007|