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. 2016 Mar;20(3):473-83.
doi: 10.1007/s10461-015-1161-4.

Armed Conflict, Substance Use and HIV: A Global Analysis

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Free PMC article

Armed Conflict, Substance Use and HIV: A Global Analysis

Bradley T Kerridge et al. AIDS Behav. .
Free PMC article

Abstract

Armed conflict is frequently assumed to be a contributor to the global HIV epidemic, but existing evidence is sparse. We examined the relationship between armed conflict between 2002 and 2008 and HIV disability life years (DALYs) in 2010 among WHO Member States. Using partial least squares analysis we also examined moderation of the armed conflict-HIV link by two susceptibility constructs (background risk, substance use) and one vulnerability mediator (numbers of refugees, people on ART, and total HIV spending). Background risk directly impacted HIV DALYs (p < 0.05), substance use moderated the conflict-HIV relationship (p < 0.01). The vulnerability construct mediated the conflict-HIV association (p < 0.01). Findings underscore the need to align HIV prevention/intervention efforts with pre-existing HIV burden and reduce the impact of natural disasters on the populace in conflict-affected states. Integration of substance prevention/harm reduction programs within national HIV responses, attention to most-at-risk populations and increased surveillance/treatment of drug resistant HIV and TB is warranted.

Keywords: Conflict; Disasters; HIV; Partial least squares structural equation modeling; Refugees; Substance use; Terrorism.

Figures

Figure 1
Figure 1
Theoretical Model of Conflict and HIV Morbidity and Mortality
Figure 2
Figure 2
Results of the Structural Equation Model: Factor Loadings and Standardized Path Coefficients

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