HIV Risk a Question of Place as Well as People

A group of American researchers now suggest that the community in which one lives is as important as an individual's behavior in determining the risk of HIV infection. "The risk of individual behavior is enhanced or lessened by the type of place in which it takes place," said study lead author Dr. Shelah S. Bloom of the University of North Carolina at Chapel Hill. Bloom and her colleagues reported their findings in Sexually Transmitted Infections (2002;78:261-266).

The researchers analyzed data from surveys conducted in a rural northern Tanzanian region with about 20,000 inhabitants between 1994 and 1997. The researchers reviewed individual risk factors for AIDS, such as HIV status, economic status, and recent health and sexual behavior histories. In addition, they assessed broader community-wide risk factors, such as economic and social activity, population mobility, distances between rural and urban centers, and the presence of female bar workers in villages across the region.

The risk of becoming infected with HIV varied across the region, they found, noting that such differences could not be fully explained by individual risk factors alone. HIV infection rates among both men and women appeared to be profoundly impacted by community characteristics. The team found that men living in villages with relatively higher rates of economic activity were almost five times more likely to be infected with HIV than those living in rural settings less involved with trade. Men living amid a more mobile population were also at a higher risk of infection. Such community risk factors also increased risk for HIV infection among women, although to a lesser degree.

The authors suggest that a relatively robust and mobile economy appears to elevate a community's risk of HIV because the local population comes into contact with a larger pool of potential sexual partners, some of whom may already be infected. While researchers found that community risk factors did not displace individual risk factors as an explanation for HIV infection rates, they concluded that individual risk rises and falls with community risk.

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