The relationship between development indicators and HIV epidemiology: a global perspective on social determinants

Despite major strides in global HIV prevention and treatment, development imbalances and gender disparities continue to shape the epidemic's burden worldwide. This study aimed to examine the associations between development indicators - including the Human Development Index (HDI), Gender Inequality Index (GII), Life Expectancy at Birth (LEaB), and Universal Health Coverage (UHC) - and HIV epidemiological measures (incidence, prevalence, mortality, and antiretroviral therapy [ART] coverage). HIV-related data for 2023 were obtained from the UNAIDS database. Countries with missing data were excluded. Relationships between development indicators and HIV metrics were analyzed using Spearman's correlation and univariable linear regression. Among 129 countries, GII correlated positively with HIV incidence (r = 0.53), prevalence (r = 0.49), and mortality (r = 0.64) (<i>p</i> < 0.001). HDI, LEaB, and UHC were inversely associated with all epidemiological measures, most strongly with mortality (HDI r = - 0.65; LEaB r = - 0.77; UHC r = - 0.58). Sub-Saharan Africa showed the highest burden alongside low development levels. Disparities were also evident in the Caribbean and Eastern Europe. Lower HDI, higher GII, and shorter life expectancy are strongly linked to a greater HIV burden. These findings highlight the need for region-specific, equity-driven strategies targeting gender inequality and healthcare access.<b>List of Abbreviations:</b> HIV, Human Immunodeficiency Virus; AIDS, Acquired Immunodeficiency Syndrome; ART, Antiretroviral Therapy; PLWH, People Living With HIV; HDI, Human Development Index; CHDI, Composite Human Development Index; GDI, Gender Development Index; GII, Gender Inequality Index; LEaB, Life Expectancy at Birth; UHC, Universal Health Coverage; UNAIDS, Joint United Nations Programme on HIV/AIDS; UNDP, United Nations Development Programme; WJP, World Justice Project; FI, Freedom Index; DI, Democracy Index; CHE, Current Health Expenditure.