Intersectional forces of urban inequality and the global HIV pandemic: a retrospective analysis
To determine how the intersection of increased urban growth and poverty has impacted HIV incidence and prevalence, given growing HIV inequalities globally. Retrospective analysis using combined data from five publicly available, population-level datasets to determine city- and within-urban countrywi...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-04-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/4/e014750.full |
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| author | Janan Dietrich Bruce D Agins Lisa M Butler Kennedy Otwombe Sidney Atwood Carissa Novak Erlyn Rachelle Macarayan Ingrid T Katz Matthew Kavanagh Blair T Johnson Alison R Schulte Liana Rosenkrantz Woskie Dana Renee Thomson Sindhu Ravishankar Zoe Siegel Erva-Jean Stevens |
| author_facet | Janan Dietrich Bruce D Agins Lisa M Butler Kennedy Otwombe Sidney Atwood Carissa Novak Erlyn Rachelle Macarayan Ingrid T Katz Matthew Kavanagh Blair T Johnson Alison R Schulte Liana Rosenkrantz Woskie Dana Renee Thomson Sindhu Ravishankar Zoe Siegel Erva-Jean Stevens |
| author_sort | Janan Dietrich |
| collection | DOAJ |
| description | To determine how the intersection of increased urban growth and poverty has impacted HIV incidence and prevalence, given growing HIV inequalities globally. Retrospective analysis using combined data from five publicly available, population-level datasets to determine city- and within-urban countrywide estimates of 95-95-95 treatment targets, prevalence and incidence rates from 2015 to 2019. For city-level estimates, we analysed combined data from: Fast-Track City (FTC), SINAN from Brazil and UNAIDS Naomi-Spectrum. Countrywide estimates of HIV prevalence in the urban slum versus non-slum since 2012 were compiled from Population-Based HIV Impact Assessment (PHIA) surveys in 12 countries and Demographic Health Surveys (DHS) in 28 countries. HIV prevalence is generally higher among the urban slum, compared to their non-slum counterparts, thus resulting in national HIV estimates masking nuances in HIV inequalities between the urban slum and non-slum. Specifically, national and city-level HIV estimates mask inequalities within and between cities, with secondary cities often having higher HIV prevalence and incidence rates than capital cities and large urban areas. The urban divide between slum and non-slum populations is a contributor to HIV inequality, often with poorer outcomes in smaller cities than their larger counterparts. Interventions tailored to cities, and particularly those considering local nuances in subpopulations (eg, different genders, ages, roles), are necessary to reduce HIV inequality. Focused HIV programming accounting for structural drivers of inequalities between urban slum and non-slum populations such as inequalities in wealth, education, employment and housing are crucial to closing gaps driving HIV inequalities globally. |
| format | Article |
| id | doaj-art-7d870e5ab8a745b6bd5ed014a00a880d |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-7d870e5ab8a745b6bd5ed014a00a880d2025-08-20T02:09:42ZengBMJ Publishing GroupBMJ Global Health2059-79082025-04-0110410.1136/bmjgh-2023-014750Intersectional forces of urban inequality and the global HIV pandemic: a retrospective analysisJanan Dietrich0Bruce D Agins1Lisa M Butler2Kennedy Otwombe3Sidney Atwood4Carissa Novak5Erlyn Rachelle Macarayan6Ingrid T Katz7Matthew Kavanagh8Blair T Johnson9Alison R Schulte10Liana Rosenkrantz Woskie11Dana Renee Thomson12Sindhu Ravishankar13Zoe Siegel14Erva-Jean Stevens15Health Systems Research Unit, South African Medical Research Council, Cape Town, South AfricaInstitute for Global Health Sciences, University of California San Francisco, San Francisco, California, USAPublic Health Sciences, Queen’s University School of Medicine, Kingston, Ontario, CanadaPerinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaBrigham and Women’s Hospital, Boston, Massachusetts, USAHarvard Global Health Institute, Cambridge, Massachusetts, USABrown University School of Public Health, Providence, Rhode Island, USAMass General Brigham, Harvard Medical School, Cambridge, Massachusetts, USAGlobal Health, Georgetown University, Washington DC, District of Columbia, USAUniversity of Connecticut Institute for Collaboration on Health Intervention and Policy, Storrs, Connecticut, USAGlobal Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USABrown University School of Public Health, Providence, Rhode Island, USAUniversity of Twente Faculty of Geo-Information Science and Earth Observation, Enschede, Overijssel, The NetherlandsInternational Association of Providers of AIDS Care, Washington, District of Columbia, USABrown University, Providence, Rhode Island, USAJoint United Nations Programme on HIV/AIDS, Geneve, SwitzerlandTo determine how the intersection of increased urban growth and poverty has impacted HIV incidence and prevalence, given growing HIV inequalities globally. Retrospective analysis using combined data from five publicly available, population-level datasets to determine city- and within-urban countrywide estimates of 95-95-95 treatment targets, prevalence and incidence rates from 2015 to 2019. For city-level estimates, we analysed combined data from: Fast-Track City (FTC), SINAN from Brazil and UNAIDS Naomi-Spectrum. Countrywide estimates of HIV prevalence in the urban slum versus non-slum since 2012 were compiled from Population-Based HIV Impact Assessment (PHIA) surveys in 12 countries and Demographic Health Surveys (DHS) in 28 countries. HIV prevalence is generally higher among the urban slum, compared to their non-slum counterparts, thus resulting in national HIV estimates masking nuances in HIV inequalities between the urban slum and non-slum. Specifically, national and city-level HIV estimates mask inequalities within and between cities, with secondary cities often having higher HIV prevalence and incidence rates than capital cities and large urban areas. The urban divide between slum and non-slum populations is a contributor to HIV inequality, often with poorer outcomes in smaller cities than their larger counterparts. Interventions tailored to cities, and particularly those considering local nuances in subpopulations (eg, different genders, ages, roles), are necessary to reduce HIV inequality. Focused HIV programming accounting for structural drivers of inequalities between urban slum and non-slum populations such as inequalities in wealth, education, employment and housing are crucial to closing gaps driving HIV inequalities globally.https://gh.bmj.com/content/10/4/e014750.full |
| spellingShingle | Janan Dietrich Bruce D Agins Lisa M Butler Kennedy Otwombe Sidney Atwood Carissa Novak Erlyn Rachelle Macarayan Ingrid T Katz Matthew Kavanagh Blair T Johnson Alison R Schulte Liana Rosenkrantz Woskie Dana Renee Thomson Sindhu Ravishankar Zoe Siegel Erva-Jean Stevens Intersectional forces of urban inequality and the global HIV pandemic: a retrospective analysis BMJ Global Health |
| title | Intersectional forces of urban inequality and the global HIV pandemic: a retrospective analysis |
| title_full | Intersectional forces of urban inequality and the global HIV pandemic: a retrospective analysis |
| title_fullStr | Intersectional forces of urban inequality and the global HIV pandemic: a retrospective analysis |
| title_full_unstemmed | Intersectional forces of urban inequality and the global HIV pandemic: a retrospective analysis |
| title_short | Intersectional forces of urban inequality and the global HIV pandemic: a retrospective analysis |
| title_sort | intersectional forces of urban inequality and the global hiv pandemic a retrospective analysis |
| url | https://gh.bmj.com/content/10/4/e014750.full |
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