Different forms of household wealth are associated with opposing risks for HIV infection in East Africa

The relationship between material wealth and HIV infection in sub-Saharan Africa has been the subject of considerable debate in part because many studies show that wealth is positively associated with infection. Others have critiqued such results, suggesting that the widely used indicators of wealth underlying these results fail to capture the diversity of livelihood portfolios in East Africa. Using population representative data from 35,799 households in Kenya, Ethiopia, and Tanzania, we estimate household wealth along two different dimensions, associated respectively with success in wage economies and agricultural economies. Regression models for men and women show consistent and opposing associations between type of wealth and HIV infection. Controlling for age, education, and urban dwelling, increasing achievement along the wage economy dimension is positively (often significantly) associated with HIV infection. In contrast, increasing achievement along the agricultural economy dimension is often negatively associated with HIV infection, and is never associated with increased HIV risk. Interestingly, variables to assess risky sexual behaviors do not mediate the relationship between either type of wealth and HIV infection. Our results suggest that future studies on the relationship between HIV and wealth need to take into account the different dimensions of household wealth found in East African countries. Our results also generate new, important questions about why and how different forms of wealth drive HIV infection.