HIV This Week

Kongnyuy EJ, Wiysonge CS, et al. Wealth and sexual behaviour among men in Cameroon. BMC Int Health Hum Rights 2006,6:11. http://www.biomedcentral.com/1472-698X/6/11

The 2004 Demographic and Health Survey (DHS) in Cameroon revealed a higher prevalence of HIV in richest and most educated people than their poorest and least educated compatriots. It is not certain whether the higher prevalence results partly or wholly from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe injections or other HIV risk factors. As unsafe sex is currently believed to be the main driver of the HIV epidemic in sub-Saharan Africa, Kongnyuy and colleagues examined the association between wealth and sexual behaviour in Cameroon among 4409 sexually active men aged 15-59 years who participated in the DHS. When controlled for potential confounding by marital status, place of residence, religion and age, men in the richest third of the population were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.43, 95% CI 0.32-0.56) and more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.38, 95% CI 1.12-1.19) and more than five lifetime sex partners (OR 1.97, 95% CI 1.60-2.43). However, there was no difference between the richest and poorest men in the purchase of sexual services. Regarding education, men with secondary or higher education were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.24, 95% CI 0.16-0.38) and more likely to have started sexual activity at age 17 years or less (OR 2.73, 95% CI 2.10-3.56) and have had more than five lifetime sexual partners (OR 2.59, 95% CI 2.02-3.31). There was no significant association between education and multiple concurrent sexual partnerships in the last 12 months or purchase of sexual services. The authors conclude that unsafe sexual behaviours may explain the higher HIV prevalence among wealthier men in the country. They add that while these findings do not suggest a redirection of HIV prevention efforts from the poor to the wealthy, they do call for efforts to ensure that HIV prevention messages get across all strata of society.

Editors’ note: It is interesting that financial ability to directly purchase sexual services is not the explanation for increased HIV in wealthier men in Cameroon. Qualitative studies would help explain the assumptions these men make about their risk of HIV in non-commercial encounters but just reflecting these findings to this population may effect a change – it’s within their power to protect themselves.