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Race, place, and HIV: The legacies of apartheid and racist policy in South Africa

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  • Bell, Griffin J.
  • Ncayiyana, Jabulani
  • Sholomon, Ari
  • Goel, Varun
  • Zuma, Khangelani
  • Emch, Michael

Abstract

Black South Africans accounted for 6.2 out of 6.4 million people living with HIV in South Africa in 2012, highlighting extreme racial disparities in HIV infection. These racial disparities are the result of structural and historical factors, specifically, the racist policies which were facilitated by segregation before, during, and after Apartheid. First, we describe the theoretical context of how racist policies and segregation are linked to HIV prevalence. Next, using data from a 2012 national survey of South Africans (SABSSM IV) and Statistics South Africa (StatsSA), we describe the race-specific geospatial distribution of HIV in South Africa, provide empirical evidence for the impact of Apartheid on important risk factors for HIV infection, and describe the relationship between these risk factors and HIV within racial groups. Using multilevel logistic regression, we find that segregation increases the odds of HIV infection among Black South Africans, even after adjusting for many covariates which are sometimes blamed, in place of structural factors, for a higher HIV prevalence in Black South Africans. We found that the estimated odds of infection in the most segregated municipality was 1.95 (95% CI: 1.15, 3.32) times the odds of infection in the least segregated municipality for Black South Africans. In addition to segregation, we also find other covariates to be differentially associated with HIV infection depending on race, such as gender, age, and sexual behavior. We also find that the HIV infection odds ratio comparing Black and Coloured (i.e., multiple ethnic groups with mixed ancestries from Africa, Asia, and Europe) South Africans varies over space. These results continue to build evidence for the influence of structural and historical factors on the modern geospatial and demographic distribution of HIV.

Suggested Citation

  • Bell, Griffin J. & Ncayiyana, Jabulani & Sholomon, Ari & Goel, Varun & Zuma, Khangelani & Emch, Michael, 2022. "Race, place, and HIV: The legacies of apartheid and racist policy in South Africa," Social Science & Medicine, Elsevier, vol. 296(C).
    • Handle: RePEc:eee:socmed:v:296:y:2022:i:c:s0277953622000582
    DOI: 10.1016/j.socscimed.2022.114755
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    1. Cécile Charasse-Pouélé & Martin Fournier, 2006. "Health Disparities between racial groups in South Africa - A decomposition Analysis," Post-Print hal-00134778, HAL.
    2. Alexander C Tsai & David R Bangsberg & Sheri D Weiser, 2013. "Harnessing Poverty Alleviation to Reduce the Stigma of HIV in Sub-Saharan Africa," PLOS Medicine, Public Library of Science, vol. 10(11), pages 1-6, November.
    3. James Levinsohn & Zoë M. McLaren & Olive Shisana & Khangelani Zuma, 2013. "HIV Status and Labor Market Participation in South Africa," The Review of Economics and Statistics, MIT Press, vol. 95(1), pages 98-108, March.
    4. Campbell, Catherine, 1997. "Migrancy, masculine identities and AIDS: The psychosocial context of HIV transmission on the South African gold mines," Social Science & Medicine, Elsevier, vol. 45(2), pages 273-281, July.
    5. Cécile Charasse-Pouélé & Martin Fournier, 2006. "Health disparities between racial groups in South Africa: a decomposition analysis," Post-Print halshs-00161711, HAL.
    6. Max-Louis G Buot & Jeffrey P Docena & Brenda K Ratemo & Matthew J Bittner & Jacob T Burlew & Aziz R Nuritdinov & Jennifer R Robbins, 2014. "Beyond Race and Place: Distal Sociological Determinants of HIV Disparities," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-15, April.
    7. Kon, Z.R. & Lackan, N., 2008. "Ethnic disparities in access to care in post-apartheid South Africa," American Journal of Public Health, American Public Health Association, vol. 98(12), pages 2272-2277.
    8. Kalipeni, Ezekiel & Oppong, Joseph & Zerai, Assata, 2007. "HIV/AIDS, gender, agency and empowerment issues in Africa," Social Science & Medicine, Elsevier, vol. 64(5), pages 1015-1018, March.
    9. Masanjala, Winford, 2007. "The poverty-HIV/AIDS nexus in Africa: A livelihood approach," Social Science & Medicine, Elsevier, vol. 64(5), pages 1032-1041, March.
    10. Hunter, Mark, 2007. "The changing political economy of sex in South Africa: The significance of unemployment and inequalities to the scale of the AIDS pandemic," Social Science & Medicine, Elsevier, vol. 64(3), pages 689-700, February.
    11. Simon N. Wood, 2003. "Thin plate regression splines," Journal of the Royal Statistical Society Series B, Royal Statistical Society, vol. 65(1), pages 95-114, February.
    12. Ronelle Burger & Caryn Bredenkamp & Christelle Grobler & Servaas van der Berg, 2012. "Have public health spending and access in South Africa become more equitable since the end of apartheid?," Development Southern Africa, Taylor & Francis Journals, vol. 29(5), pages 681-703, December.
    13. Stoebenau, Kirsten & Heise, Lori & Wamoyi, Joyce & Bobrova, Natalia, 2016. "Revisiting the understanding of “transactional sex” in sub-Saharan Africa: A review and synthesis of the literature," Social Science & Medicine, Elsevier, vol. 168(C), pages 186-197.
    14. Tina Fransman & Derek Yu, 2019. "Multidimensional poverty in South Africa in 2001–16," Development Southern Africa, Taylor & Francis Journals, vol. 36(1), pages 50-79, January.
    15. Burger, Ronelle & Christian, Carmen, 2020. "Access to health care in post-apartheid South Africa: availability, affordability, acceptability," Health Economics, Policy and Law, Cambridge University Press, vol. 15(1), pages 43-55, January.
    16. Mary Kate Grabowski & Justin Lessler & Jeremiah Bazaale & Dorean Nabukalu & Justine Nankinga & Betty Nantume & Joseph Ssekasanvu & Steven J. Reynolds & Robert Ssekubugu & Fred Nalugoda & Godfrey Kigoz, 2020. "Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda," Nature Communications, Nature, vol. 11(1), pages 1-12, December.
    17. Norris, Alison H. & Kitali, Amani J. & Worby, Eric, 2009. "Alcohol and transactional sex: How risky is the mix?," Social Science & Medicine, Elsevier, vol. 69(8), pages 1167-1176, October.
    18. Charasse-Pouélé, Cécile & Fournier, Martin, 2006. "Health disparities between racial groups in South Africa: A decomposition analysis," Social Science & Medicine, Elsevier, vol. 62(11), pages 2897-2914, June.
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