Socio-economic Status And HIV Transmission Dynamics In Papua New Guinea.

We all accept that the socioeconomic status (SES) directly affects the risk of HIV/AIDS. For example, low SES is associated with a high risk of acquiring HIV and a high SES is associated with a low risk. But in PNG it seems this association is only academic. People of high SES (eg mine workers, accountants) are being infected with HIV at the same rate as people with low SES.

I was pondering on this issue and just said to myself – we really do not know the factors governing the dynamics affecting this transmission rates. And we are doing massive awareness and campaigns without really understanding what really affects an individual to get infected. The well known factors such as poverty, unemployment, SES, gender inequality and so forth. But I think we are really not attacking the issue of sex. Why do people seek that one night stand, or being promiscuous. That is the thing which gets one infected with HIV right? I mean a “poor” person who is faithfully married and does not go looking for pamuks or occasional one night stands will not get AIDS. I am going off in a tangent from what I was trying to say about HIV transmission dynamics in PNG.

My proposal scheme for understanding HIV transmission dynamics in PNG 

What I think is a very simplistic scheme but I think it makes it easier to understand what is going on in PNG, at least in theory. This is just theoritical so comments welcome.

 Say we categorise each suburb/settlement, in Port Moresby into low SES, middle SES and high SES. We can use indies such as average wage of someone living in that suburb, services available, crime rate, average household and number of people working and other factors for each suburb. I am of course aware that some prominent people in PNG live in “poor’ suburbs (eg settlements). But I am talking about the overall SES of the suburb/settlement.

From what we already know about factors affecting HIV transmission, what we can create is a SES pyramid– Low SES forming the base of the pyramid, Middle SES in the middle and High SES at the top. Now, we know that as you go higher up the SES pyramid the risk associated with HIV transmission decreases.

What I  think is happening in PNG is this. There is a level of HIV being transmitted among individuals living at the bottom of the pyramid, and this is a horizontal transmission process. The same horizontal transmission is happening among individuals in the middle of the pyramid (ie middle SES) and that same horzontal transmission process is happeing at the top of the pyramid, the high SES. But bear in mind that the risk is low at the top. This is because other factors like education and williness to use a condom play a part. For example theoretically a person of low SES is less likely to use a condom than someone of high SES.

OK, now apart from this horizontal transmission that is happening, there is also vertical transmission of HIV along the SES pyramid I described above. That is, there is vertical transmission from low SES to middle SES and from middle SES to high SES. And more importantly, and this just my view, is that there is also A LOT of vertical transmission between the low SES and high SES.

But, the question I have been asking myself is, this SES pyramid scheme is simplistic and at least for me, helps me understand and put into perspective what is happening at the suburban level in major towns in PNG. Oh Yes the question, the question is – if i liken the transmission that is happening horizontally and vertically in the SES pyramid is like “traffic flow”, can I measure that “traffic flow?”, and if so how can I measure that “traffic flow?” If I can measure it and give it some index then I will know how much “traffic” is flowing horizontally at the low SES pyramid, or how much “traffic” is flowing vertically between the low SES and middle SES in the SES pyramid. The same can be known about the “traffic” flow between low SES and high SES levels at the SES pyramid.

If I use a diagram to explain it will be much simpler to see what I am saying and maybe makes sense. But I hope you can see what I am saying.

Therefore if we know how much “traffic flow” is within and among this SES pyramid, it will help us to direct the efforts of HIV/AIDS prevention programs where it will have the maximum effect in interrupting the transmission.

This is all just theoretical and academic but I think it makes interesting discussion and makes an interesting research topic.


About rodney itaki

Medical doctor and public health specialist from Papua New Guinea.
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