Social and structural vulnerability to HIV infection in Uganda: A multilevel modelling of AIDS indicators survey data, 2004-2005 and 2011

Introduction: Sub Saharan Africa (SSA) continues to exhibit inequalities in HIV epidemic. As of 2017, about 69.5% of people living with HIV, 64% of new infections and 73% HIV-related deaths were in SSA. Most HIV research conducted in the continent has focused on individual-level factors. Objectives: This research identifies social and structural factors that increase vulnerability to HIV; and estimates the effect of community-level factors in increasing vulnerability to HIV infection. Methods: Multilevel binary logistic regression is applied to 39,766 individual cases with HIV test results obtained in 887 clusters of Uganda HIV/AIDS Indicators Survey conducted in 2004-2005 and 2011. Findings: After controlling for individual-level factors, living in a community with a higher proportion of wealthy households (Average Odds Ratio=1.07, CI [1.03–1.11], with more former married individuals (AOR=1.21, CI [1.09–1.33]), with a higher proportion of people drunk with alcohol before unsafe sex (AOR=1.11, CI [1.05–1.18]), and living in a community where a higher proportion of people believe it is okay for a woman to ask her sexual partner to use a condom (AOR=1.08, CI [1.02–1.15]) was significantly associated with being HIV positive. However, living in a community where a higher proportion of men practiced polygamy was associated with reduced vulnerability to the risk of HIV infection (AOR=0.91, CI [0.85–0.98]). Conclusion: Community factors influence vulnerability to the risk of HIV infection in Uganda. Immediate efforts to prevent HIV infection need to focus on community awareness about the influence of these factors, and long-term efforts need to address the broader determinants of these practices.