Background: As high HIV transmission rates persist in Sub-Saharan Africa, the effect of wealth inequality rather than solely absolute wealth as a potential driver of the HIV epidemic has been given increased attention in recent research, but has not yet been investigated in the Nigerian setting. As, particularly in contexts of socioeconomic inequality, individuals may face barriers to both obtaining health-related knowledge and translating this knowledge into actual engagement in preventive measures, it is relevant to assess the level of HIV-related knowledge in the Nigerian population. Furthermore, it is of interest to investigate its socioeconomic predictors, and to identify risk-groups for low HIV-related knowledge, which consequentially are also potential risk groups for high HIV transmission. This will ultimately facilitate the targeting and implementation of more appropriate and effective preventive interventions among these groups. Due to the country’s high HIV prevalence and its ethnic and socioeconomic heterogeneity, it is both an interesting and highly relevant setting in which to analyse the socioeconomic determinants of HIV-related knowledge. Methods: Utilizing data from the Nigerian Demographic and Health Survey, Paper 1 of this thesis investigates wealth inequality as a predictor of low HIV-related knowledge in the Nigerian population through logistic regression modeling. The effects of other sociodemographic factors such as sex, literacy and rural or urban residence on HIV-related knowledge are also explored. In paper 2, a trend analysis is conducted of HIV-related knowledge in the country from 2003 to 2013, with changes in these trends represented graphically, stratified by various sociodemographic factors. ARIMA models were fit to the 2003-2013 trend data. Finally, Paper 3 presents a systematic review (using the Medline and Embase databases) and meta-analysis (conducted in R) of HIV-related knowledge interventions in Sub-Saharan Africa or among the African Diaspora, synthesising the available evidence for the efficacy of such interventions in 1) improving HIV-related knowledge, 2) resulting in increased engagement in preventive measures and safe sexual practices, and 3) reducing HIV incidence. Random-effects models were used for the meta- analyses. Results: The logistic regression model indicated that females were more than twice as likely as males to have low HIV-related knowledge in each wealth inequality category. In addition, females were more likely to have correct knowledge of mother-to-child transmission than males, but were over 1.5 times more likely to have poor knowledge of HIV risk reduction measures. Individuals with lower literacy levels were almost twice as likely as literate respondents to have low HIV-related knowledge. Ethnicity, religious affiliation, relationship status, and residing in rural areas were additional significant predictors of HIV-related knowledge. The trend analysis indicated an overall increase in HIV-related knowledge between 2003 and 2013, but a decrease in knowledge of mother-to-child-transmission. In addition, State-level disparities in knowledge regarding HIV risk reduction increased over time. The meta-analysis of HIV education interventions demonstrated significantly higher odds of correct knowledge of transmission routes as well as condom use, but insignificantly lower odds of HIV incidence. Conclusions: HIV-related knowledge in this sample is generally low among females, those with low literacy levels, the poor, the unemployed, those residing in rural areas, those with traditional religious beliefs, and those living in states with the highest wealth inequality ratios. The meta-analysis of HIV-related knowledge interventions in Paper 3 indicates that such interventions are generally effective at improving not only HIV-related knowledge but also increasing condom use, and should thus be targeted at the risk groups identified in Papers 1 and 2, in order to work towards the reduction of HIV transmission.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/37765 |
| Date | 05 June 2018 |
| Creators | Faust, Lena |
| Contributors | Yaya, Sanni |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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