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. 2018 Feb 9:3:6.
doi: 10.1186/s41256-018-0061-3. eCollection 2018.

Cross-country Association of Press Freedom and LGBT freedom with prevalence of persons living with HIV: implication for global strategy against HIV/AIDS

Xinguang Chen  1 , Amy L Elliott  1 , Shuang Wang  1
Affiliations

Cross-country Association of Press Freedom and LGBT freedom with prevalence of persons living with HIV: implication for global strategy against HIV/AIDS

Xinguang Chen et al. Glob Health Res Policy. .

Abstract

Background: Human behaviors are affected by attitudes and beliefs, which in turn are shaped by higher-level values to which we have ascribed. In this study, we explore the relationship between two higher-level values, press freedom and LGBT freedom, and HIV infection with national data at the population level.

Methods: Data were the number of persons living with HIV (PLWH, n = 35,468,911) for 148 countries during 2011-15, press freedom index (PFI) determined by the Reporters Without Borders, and LGBT freedom index (LGBT-FI) based on laws regulating same-sex relationships and expression. PLWH prevalence (1/1000), PFI and LGBT-FI were mapped first. Multiple regression was thus used to associate the logarithm of PLWH prevalence with PFI, LGBT-FI and PFI × LGBT-FI interaction, controlling for per capita GDP and weighted by population size.

Results: Global prevalence of PLWH during 2011-15 was 0.51 per 1000 population. The prevalence showed a geographic pattern moving from high at the south and west ends of the world map to low at the north and east. Both PFI and LGBT-FI were positively associated with PLWH prevalence with a negative interaction between the two.

Conclusions: More people are infected with HIV in countries with higher press freedom and higher LGBT freedom. Furthermore, press freedom can attenuate the positive association between levels of LGBT freedom and risk of HIV infection. This study demonstrated the urgency for and provided data supporting further research to investigate potential cultural and socioecological mechanisms underpinning the complex relationship among press freedom, LGBT freedom and HIV infection, with data collected at the individual level.

Keywords: Core values; Global health; HIV/AIDS epidemiology; LGBT freedom; Press freedom.

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Conflict of interest statement

Not applicable.The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Global patterns of the prevalence rates (1/1000 population) of persons living with HIV (PLWH), 2011-2015 (Source: Created with data from UNAIDS and other sources)
Fig. 2
Fig. 2
2015 Global pattern of Press Freedom Index with larger numbers indicating higher levels of press freedom (Source: Created using data from the Reporters Without Borders)
Fig. 3
Fig. 3
Global pattern of LGBT Freedom with larger numbers indicating higher levels of LGBT freedom (Source: Created with data from Wikipedia Commons on laws related to same-sex relationships and expression by country. See text in 2.1 for a detailed definition)
Fig. 4
Fig. 4
Interaction between press freedom index (PFI) and LGBT freedom index (LGBT-FI) in association with PLWH prevalence across 148 countries in the world (Source: Created with data from the UNAIDS, Doctors Without Borders, and Wikipedia Commons)
See this image and copyright information in PMC

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