{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T18:04:43Z","timestamp":1779386683085,"version":"3.53.1"},"reference-count":104,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>While economic vulnerability is an established driver of health disparities, the relationships between HIV and wealth, income, and economic inequality have been less consistently established. We conducted a systematic review of studies examining associations between wealth, income, and economic inequality and HIV incidence and prevalence in sub\u2010Saharan Africa (SSA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, we searched PubMed, SCOPUS, Embase, EconLit and PsycINFO for quantitative publications through June 2024 examining the relationship between wealth, income or inequality and HIV status, acquisition, prevalence or incidence in SSA. From September 2022 to October 2024, we extracted data using standardized forms, assessed risk of bias and qualitatively summarized results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 47 studies covering 48 countries met the inclusion criteria. Studies had generally low risk of bias, and most focused on a single country (\n                      <jats:italic>n<\/jats:italic>\n                      = 38), assessed household wealth as the exposure (\n                      <jats:italic>n<\/jats:italic>\n                      = 36) and employed cross\u2010sectional designs (\n                      <jats:italic>n<\/jats:italic>\n                      = 33). Studies assessing wealth and HIV incidence consistently identified a protective effect, while findings around HIV incidence and income were mixed. In studies assessing HIV prevalence, findings on HIV and individual and household income or wealth were mixed. Economic inequality was consistently associated with increased HIV prevalence at community, sub\u2010national and national levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Most included studies were cross\u2010sectional, among the general population, and secondary analyses of existing data. These can generate new insights about potential economic predictors of HIV, but longitudinal research is needed to understand economic impacts on HIV in evolving programme and policy contexts. Limited studies outside the general population highlighted opportunities for future research exploring economic drivers of HIV among the key population and potential differences in the HIV\u2010wealth relationship by gender and urbanicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The evidence on HIV and wealth or income is mixed and varies by setting and population, while a limited literature suggests that economic inequality is more consistently associated with HIV risk. Longitudinal research is needed to assess causal relationships between economic factors and HIV, and to identify potential mediators of this relationship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70060","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T10:04:18Z","timestamp":1766484258000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Wealth, income and HIV in sub\u2010Saharan Africa: a systematic review"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8302-542X","authenticated-orcid":false,"given":"Kaitlyn","family":"Atkins","sequence":"first","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7066-3841","authenticated-orcid":false,"given":"Kirsty M.","family":"Sievwright","sequence":"additional","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health Johns Hopkins University  Baltimore Maryland USA"},{"name":"HIV Center for Clinical and Behavioral Studies Division of Gender Sexuality and Health Columbia University\/New York State Psychiatric Institute  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health Johns Hopkins University  Baltimore Maryland USA"},{"name":"Department of Medicine Center for AIDS Prevention Studies University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6820-063X","authenticated-orcid":false,"given":"Caitlin E.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of International Health Bloomberg School of Public Health Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.2307\/2626958"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(98)00385-2"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyh338"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/30.6.1397"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3282f2aac3"},{"key":"e_1_2_11_7_1","unstructured":"United Nations Joint Programme on HIV\/AIDS (UNAIDS).The path that ends AIDS: UNAIDS Global AIDS Update 2023.Geneva;2023."},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","unstructured":"World Bank.Sub\u2010Saharan Africa 2023. 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