New Study: HIV/AIDS Most Prevalent Among Africa's "Richest"

In a controversial new study presented at the ongoing PEPFAR conference in Durban and reported in Wednesday's Boston Globe, researchers at ORC Macro have concluded that wealthy people (the top quintile) in Africa are infected with HIV/AIDS at higher rates than poorer people. These finding contradict widely held beliefs and undermine the notion that poverty is a main driver of AIDS. According to Vinod Mishra, director of research at ORC Macro, the findings show that “poverty-driven programs are likely to have limited impact on prevention efforts when the majority of the infected people are the wealthiest, not the poorest.” The issue of targeting prevention efforts that was raised by this study is a good and important question and begs more exploration and evaluation to determine who is reached by ongoing prevention programs and how that can be improved. However, as critics were keen to point out, these findings threaten to gloss-over two important dynamics when being translated to policies and practice: 1) that 90% of the people in Africa are poor, meaning that the wealthiest quintile in many of these countries represent many people who are still characterized as poor; and 2) that although perhaps not infected as the highest rates, the poorest people tend to face the most dramatic and devastating impacts from the disease. While these new data and findings are fascinating and critical, I hope they do not overly detract from these other realities in the constant give and take of donor funding and program priority-setting. Why not target the poor and the less poor?