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South Africa: Women of lower socio-economic status have greater needs for services to prevent mother-to-child HIV transmission
Lesley Odendal, 2015-07-15 11:00:00

Pregnant women of lower socio-economic status are more likely to take up early HIV testing and to have HIV-exposed infants, according to findings of a study presented by Nobubelo Ngandu at the 7th South African AIDS conference last month in Durban.

There was a significant difference in the proportion of infants that were HIV-exposed (infants born to HIV-positive women), according to socio-economic status. Infant exposure occurred in 37.9% (95% CI: 34.4 – 41.4) in the lowest 10% of the socio-economic status ranking, compared to 23.5% (95% CI: 20.5 – 26.8) in the highest 10% and 33.2% (95% CI: 32.1 – 34.3) in the sample average.

In the highest-status 10%, only 18.7% (95% CI: 16.0 – 21.7) self-initiated HIV testing before enrolling into antenatal care (early testing), compared to 23.8% (95% CI: 20.9 – 27.0) in the lowest-status 10% and 22.4% (95% CI: 21.4 – 23.4) in the sample average. However, this difference was not significant.

Socio-economic status is an important determinant of healthcare uptake. Studies have illustrated examples of wealth-related inequalities in maternal and child health care in low and middle-income countries, such as access to skilled birth attendance and antenatal care and early uptake of HIV testing. As wealth-related inequality is generally very high in South Africa, this study sought to understand if this was affecting the PMTCT programme. 

Transport, income source, the province where the mother and infant live and the education level of the mother were the main factors found to be contributing to wealth inequality. There are complex differences between provinces in terms of early HIV testing and infant HIV exposure, which weaken the reliance on national average data, often used by HIV programme planners.

Socio-economic status (wealth ranking) was measured for 8 618 mother-infant pairs and categorised into the highest 10% (n=818) and the lowest 10% (n=863), according to variations in household characteristics (such as building material, sanitation, water and fuel) and household possessions (such as car, television, radio, fridge, phone or stove), using Principal Component Analyses. The study was part of the 2012 South Africa national PMTCT cross-sectional survey, which collated data from 580 randomly selected health care facilities between October 2012 and May 2013.

When wealth-related inequality was measured using the concentration index to compare the cumulative proportion of a health outcome and individuals ranked by socio-economic status, it was found that uptake of early HIV testing is slower and that infant HIV exposure increases faster among the lower socio-economic status groups.  

However, the wealth-related inequality is underestimated by this sample, as the data is only relevant to communities using accessible public health facilities. The most remote and difficult to access rural facilities and private sector facilities are not very well represented.

“Policies for healthcare provision should consider disparities between socio-economic groups to ensure equity,” said Ngandu.