Conflict, substance use and HIV: A global analysis

This study developed and tested a longitudinal explanatory model of the relationship between conflict (between 2002-2008) and HIV disability-adjusted life years (DALYs) among WHO Member States.  This model differentiated between pre-existing background susceptibility factors and vulnerability factors that serve as moderating and mediating processes, respectively, through which conflict affects HIV morbidity/mortality.  Data on conflict, 2010 HIV attributable DALYs and susceptibility and vulnerability factors consisted of country-level data assembled from multiple sources.  Partial least squares structural equation modeling was used to test the model.  The first susceptibility construct (per capita alcohol consumption, injection drug use prevalence and illicit drug use prevalence indicators) served as a moderator of the conflict-HIV association (t = 1.74, p < 0.05) while the second susceptibility construct (ethnic heterogeneity, baseline HIV prevalence and natural disaster indicators) directly served to increase HIV DALYs (t = 6.52, p < 0.05).  The vulnerability construct consisting of the number of people on ART, total spending on HIV and number of refugees, was shown to mediate the conflict-HIV association (conflict → vulnerability construct; t = 6.62, p < 0.05; vulnerability construct → HIV DALYs, t = 8.65, p < 0.05).  This study suggested that HIV interventions for conflict prone states include programs to reduce rates of alcohol use/illicit drug use, to reduce impact of natural disasters and conflict on the populace, especially refugees and to address inequality resulting from discrimination.  The results suggest global-wide attention to HIV and TB drug resistance in the form of surveillance and treatment.