Correlates of national HIV seroprevalence: an ecologic analysis of 122 developing countries.

BACKGROUND Ecologic analyses of social and developmental correlates of country-level HIV seroprevalence may suggest strategies for combating the HIV/AIDS epidemic. METHODS Regression analyses were performed for 81 variables obtained primarily from United Nation agencies for 122 developing countries. Variable measures were compared between highest and lowest tertiles of HIV seroprevalence. RESULTS Geography, religion, and income inequality were independently associated with HIV seroprevalence. Countries with earlier ages at first sex, higher teenage birth rates, and higher fertility rates had higher HIV seroprevalence. Countries with high HIV seroprevalence had fewer women using contraceptives, more persons with casual sex partners, and higher herpes simplex virus 2 seroprevalence. Male circumcision and Muslim religion were colinearly associated with lower HIV seroprevalence. Countries with high HIV seroprevalence had fewer doctors, more midwives, and less access to essential medications, but health spending differences were minor. CONCLUSIONS Ecologic analyses support population-level behavioral approaches, such as delaying sexual debut and discouraging casual sex partners, and reinforce biologic measures, such as controlling sexually transmitted infections and promoting male circumcision, for HIV prevention. Fewer births attended by skilled personnel, but more midwives, in countries with the highest HIV seroprevalence suggest potential strategies for reducing mother-to-child transmission. Correlations with selected health indicators suggest additional obstacles for implementing HIV treatment programs.