Gender and poverty in South Africa in the era of HIV/AIDS: a quantitative study

BACKGROUND: Recent research identifies gender inequality as a driver of the HIV/AIDS epidemic. The feminization of poverty is also increasingly apparent, as is the disproportionate vulnerability of members of female-headed households. We sought to examine the relationships among sex, gender, age, HIV status, and socioeconomic characteristics, focusing on heads and nonheads of households. METHODS: We interviewed 6,338 men and 10,057 women. RESULTS: Significantly more males (51.4%) than females (34.8%) indicated that they were heads of households (p < 0.001). Female heads of households were significantly more likely to be infected with HIV than their male counterparts (17.9% vs. 13.1%). Among 15-24-year-old males, those who are often without cash are more likely to be infected with HIV than those who are never without cash (OR = 3.33, 95% CI 1.17-9.49). Similar results were observed among females, who sometimes had no cash (OR = 1.86, 95% CI 1.22-2.82), and among adults aged >or=25 years. Results confirmed that age and gender are related to HIV infection in South Africa and that poverty is a social determinant for HIV infection across all age groups. However, sex is a determinant only among the younger age groups. Young female heads of household are more likely to be poor and are more likely to be HIV positive. CONCLUSIONS: The results indicate that the HIV/AIDS epidemic in South Africa is characterized by gender inequalities. Young women are more likely to be HIV infected, especially heads of households. Young women are also more likely to live in poverty, although this study cannot establish the directionality of a causative relationship between poverty and risk of HIV. Greater attention must be paid to young women, especially those who head households, in terms of treatment, prevention, and poverty alleviation.