Skip to main content

Advertisement

SpringerLink
Log in

Drought and disproportionate disease: an investigation of gendered vulnerabilities to HIV/AIDS in less-developed nations

  • Original Paper
  • Published:
Population and Environment Aims and scope Submit manuscript

Abstract

Environmental change and climate-related disasters are an under-examined factor impacting women’s health, globally. Drawing on ecofeminist theory, we conduct analyses examining if the HIV burden among women is higher in nations that experience suffering from droughts. Specifically, we posit that droughts, which typically impact more people and for greater lengths of time than other climate-related disasters, have a unique impact on women’s vulnerability to HIV/AIDS. We use a cross-national dataset of less-developed countries and ordinary least squares (OLS) regression to explore and compare relationships between suffering from drought and total HIV prevalence and suffering from drought and women’s proportion of HIV cases. Overall, the results demonstrate that while droughts have an inconsistent impact on total HIV prevalence, suffering from drought significantly increases the proportion of HIV cases among women in comparison to men, net of the impact of common economic, social, cultural, and political predictors. The findings suggest that suffering from drought differentially impacts women’s health in less-developed countries, where a number of mechanisms, such as transactional sex or displacement, likely underlie the associations identified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Throughout this article, less-developed countries are defined as countries falling within the lower three quartiles of the World Bank income classification of countries, which is based on per capita GDP.

  2. Other types of transactional sex exist and are important to consider, including sex for improvement of social status and sex for material expressions of love (Mojola 2014; Stoebenau et al. 2016) through securing of material goods rather than food (Leclerc-Madlala 2008; Wamoyi et al. 2010, 2019). However, regardless of the motivations being for basic survival items or for more luxury items, we emphasize that devastation from drought may encourage women to engage in transactional sex to obtain the things they need or want.

  3. We acknowledge that violent conflict also likely exacerbates the effects of drought and is also a major contributor to displacement. Droughts are likely to be acutely devastating in nations with pre-existing conflict (e.g., Somalia). While relevant to ideas about displacement and IDP camps, we prefer to focus on drought rather than conflict in the current manuscript for the sake of parsimony, and as the relationship between drought and HIV is a new line of research which first deserves a fundamental approach. Certainly, considering the role of conflict alongside these themes represents an avenue for future research.

  4. We employed a number of diagnostic tests, including Cook’s D, Breush-Pagan, and modified White’s tests to examine potential patterns in heteroscedasticity, the existence of outliers, etc.

  5. We follow Paul Allison (2012), where he conservatively recommends concerns over multicollinearity when individual VIFs exceed 2.5.

  6. We also considered other time-lags (e.g., 4–8-year lags) used in prior research and obtained consistent results.

  7. We also tested all models using the complete sample of 65 cases. The results were entirely consistent with those presented here. However, we prefer to present models on as many cases as possible; thus, we retained all 69 cases in the sample and only have a reduced sample size for those models including number of trained health workers.

  8. We also considered analyses predicting female HIV prevalence. However, these models did not yield any interesting or new results. Austin and Noble (2014) provide a clear discussion and analysis of women’s HIV prevalence versus women’s proportion of HIV cases, demonstrating that total prevalence and female prevalence of HIV are correlated at 0.99 in cross-national data and that analyses of female prevalence rates do not appropriately capture the drivers of women’s disproportionate vulnerability to HIV/AIDS. We also utilized data on female HIV prevalence and found consistent results with those presented here for total HIV prevalence. We focused our analyses to presenting the findings for total HIV prevalence and women’s proportion of the population living with HIV for parsimony and to more succinctly demonstrate environmental change as a gendered health issue.

  9. We also tried additional time windows when calculating the droughts measure, ranging from 3 to 15 years. The impacts of droughts on women’s proportion of the population living with HIV and total HIV prevalence were overwhelmingly consistent with the results presented here regardless of the timespan used to measure the variable.

  10. We also tested models with additional control variables related to women’s empowerment, including fertility rates, the percent of births attended by trained health staff, female primary school enrollments, and the Gender Inequality Index. These models were excluded from the main results for the sake of parsimony, but they are available in the Appendix Table 5.

  11. In early models, we also tested for the influence of the other key macro-regions represented by the countries in the sample, including Latin America and Southeast Asia. However, the dummy indicators for these two regions were non-significant.

References

  • Allison, P. (1999). Multiple regression: a primer. Thousand Oaks: Pine Forge Press.

    Google Scholar 

  • Allison, P. (2012). When can you safely ignore multicollinearity? Statistical Horizons. Retrieved from https://statisticalhorizons.com/multicollinearity.

  • Arku, F. S., & Arku, C. (2010). I cannot drink water on an empty stomach: a gender perspective on living with drought. Gend Dev, 18(1), 115–124.

    Google Scholar 

  • Austin, K. F., & Noble, M. D. (2014). Measuring gender disparity in the HIV pandemic: a cross-national investigation of female empowerment, inequality, and disease in less-developed nations. Sociol Inq, 84(1), 102–130.

    Google Scholar 

  • Austin, K. F., & McKinney, L. (2016). Disaster devastation in poor countries: the direct and indirect effects of ecological losses, gender inequality, and development. Social Forces, 95(1), 355–380.

    Google Scholar 

  • Austin, K. F., Choi, M., & Berndt, V. (2017). Trading sex for security: unemployment and the unequal HIV burden among young women in developing nations. Int Sociol, 32(3), 343–368.

    Google Scholar 

  • Austin, J., Guy, S., Lee-Jones, L., McGinn, T., & Schlecht, J. (2008). Reproductive health: a right for refugees and internally displaced persons. Reproductive Health Matters, 16(31), 10–21.

    Google Scholar 

  • Bose, C. E. (2011). Eastern sociological society presidential address: globalizing gender issues: many voices, different choices. Sociol Forum, 26(4), 739–753.

    Google Scholar 

  • Braun, Y. A. (2011). Drought. In M. Z. Strange, C. K. Oyster, & J. E. Sloan (Eds.), The multimedia encyclopedia of women in today’s world (pp. 427–428). Thousand Oaks: Sage Publications.

    Google Scholar 

  • Burroway, R. (2010). Schools against AIDS: secondary school enrollment and cross-national disparities in AIDS death rates. Soc Probl, 57(3), 398–420.

    Google Scholar 

  • Burroway, R. (2012). A cross-national analysis of sex-specific HIV prevalence rates and women’s access to property, land, and loans in developing countries. Int J Sociol, 42(2), 47–67.

    Google Scholar 

  • Campbell, J. C., Baty, M. L., Ghandour, R. M., Stockman, J. K., Francisco, L., & Wagman, J. (2008). The intersection of intimate partner violence against women and HIV/AIDS: a review. Int J Inj Control Saf Promot, 15(4), 221–231.

    Google Scholar 

  • Cook, B. I., Mankin, J. S., & Anchukaitis, K. J. (2018). Climate change and drought: from past to future. Current Climate Change Reports, 4(2), 164–170.

    Google Scholar 

  • CRED (Centre for the Research on the Epidemiology of Disasters). (2019). Disasters in Africa: 20 year review (2000-2019). CRED Crunch, 56, 1–2.

    Google Scholar 

  • Denton, F. (2002). Climate change vulnerability, impacts, and adaptation: why does gender matter? Gend Dev, 10(2), 10–20.

    Google Scholar 

  • Dunaway, W. A., & Macabuac, M. C. (2007). “The shrimp eat better than we do”: Philippine subsistence fishing households sacrificed for the global food chain. Review, 30(4), 313–327.

    Google Scholar 

  • Dunkle, K. L., Jewkes, R. K., Brown, H. C., Gray, G. E., McIntryre, J. A., & Harlow, S. D. (2004). Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med, 59(8), 1581–1592.

    Google Scholar 

  • Eaton, H., & Lorentzen, L. A. (2003). Ecofeminism & globalization: exploring culture, context, and religion. Lanham: Rowman & Littlefield Publishers.

    Google Scholar 

  • Elmhirst, R. (2011). Introducing new feminist political ecologies. Geoforum, 42(2), 129–132.

    Google Scholar 

  • EM-DAT. (2015). The International Disaster Database. Retrieved from http://www.emdat.be/database.

  • Enarson, E. (2000). Gender and Natural Disasters [PDF file]. Retrieved from https://www.ilo.org/wcmsp5/groups/public/%2D%2D-ed_emp/%2D%2D-emp_ent/%2D%2D-ifp_crisis/documents/publication/wcms_116391.pdf.

  • Enarson, E., Fothergill, A., & Peek, L. (2018). Gender and disaster: foundations and new direction for research and practice. In H. Rodriguez, W. Donner, & J. E. Trainor (Eds.), Handbook of disaster research (2nd ed., pp. 205–233). New York: Springer.

    Google Scholar 

  • Ergas, C., & York, R. (2012). Women’s status and carbon dioxide emissions: a quantitative cross-national analysis. Soc Sci Res, 41(4), 965–976.

    Google Scholar 

  • FAO (Food and Agriculture Organization of the United Nations). (2011). Drought-related food insecurity: a focus on the horn of Africa. Retrieved from http://www.fao.org/3/mb738e/mb738e.pdf.

  • FAO (Food and Agriculture Organization of the United Nations). (2020). Drought. Retrieved from http://www.fao.org/land-water/water/drought/en/.

  • Fisher, M., & Carr, E. R. (2015). The influence of gendered roles and responsibilities on the adoption of technologies that mitigate drought risk: the case of drought-tolerant maize seed in Eastern Uganda. Glob Environ Chang, 35, 82–92.

    Google Scholar 

  • Fothergill, A., & Peek, L. (2004). Poverty and disasters in the United States: a review of recent sociological findings. Nat Hazards, 32, 89–110.

    Google Scholar 

  • Frank, E., & Unruh, J. (2008). Demarcating forest, containing disease: land and HIV/AIDS in southern Zambia. Popul Environ, 29(3), 108–132.

    Google Scholar 

  • Freedom House. (2011). Freedom in the World 2011. Retrieved from https://freedomhouse.org/report/freedom-world/freedom-world-2011.

  • Gaard, G. (2011). Ecofeminism revisited: rejecting essentialism and re-placing species in a material feminist environmentalism. Fem Form, 23(2), 26–53.

    Google Scholar 

  • Gaard, G. (2015). Ecofeminism and climate change. Women's Stud Int Forum, 49, 20–33.

    Google Scholar 

  • Gaard, G. (2017). Critical ecofeminism. NY: Lexington.

    Google Scholar 

  • Gerber, N., & Mirzabaev, A. (2017). Benefits of action and costs of inaction: drought mitigation and preparedness – a literature review [PDF file]. World Meteorological Organization, Integrated Drought Management Programme Working Paper No. 1. Retrieved from http://www.droughtmanagement.info/literature/IDMP_BACI_WP.PDF.

  • Godfrey, P. C. (2012). Introduction: race, gender & class and climate change. Race, Gender & Class, 19(1/2), 3–11.

    Google Scholar 

  • Gray, P. B. (2004). HIV and Islam: is HIV prevalence lower among Muslims? Soc Sci Med, 58(9), 1751–1756.

    Google Scholar 

  • Guha-Sapir, D. (2012). Disaster data: a balanced perspective. CRED Crunch, 28, 1–2.

    Google Scholar 

  • Hankivsky, O. (2012). Women’s health, men’s health, and gender and health: Implications of intersectionality. Soc Sci Med, 74, 1712–1720.

    Google Scholar 

  • Harlan, S. L., Pellow, D. N., Roberts, J. T., Bell, S. E., Holt, W. G., & Nagel, J. (2015). Climate justice and inequality. In R. E. Dunlap & R. J. Brulle (Eds.), Climate change and society: sociological perspectives (pp. 127–163). Oxford: Oxford University Press.

    Google Scholar 

  • Heimer, C. A. (2007). Old inequalities, new disease: HIV/AIDS in Sub-Saharan Africa. Annu Rev Sociol, 33, 551–577.

    Google Scholar 

  • Horton, L. (2012). After the earthquake: gender inequality and transformation in post-disaster Haiti. Gend Dev, 20(2), 295–308.

    Google Scholar 

  • Hunter, L. M., Reid-Hresko, J., & Dickinson, T. W. (2011). Environmental change, risky sexual behavior, and the HIV/AIDS pandemic: linkages through livelihoods in rural Haiti. Popul Res Policy Rev, 30(5), 729–750.

    Google Scholar 

  • King, Y. (1999). Ecofeminism. In W. P. Mankiller, G. Mink, M. Navarro, B. Smith, & G. Steinem (Eds.), The reader’s companion to U.S. women’s history (p. 207). Boston, MA: Houghton Mifflin Company.

  • Leclerc-Madlala, S. (2008). Transactional sex and the pursuit of modernity. Soc Dyn, 29(2), 213–233.

    Google Scholar 

  • Lungu, A., & Hüsken, S. M. C. (2010). Assessment of access to health services and vulnerabilities of female fish traders in the Kafue Flats, Zambia. Zambia: analysis report. Retrieved from http://aquaticcommons.org/4143/1/WF_2700.pdf.

  • Majid, N., & McDowell, S. (2012). Hidden dimensions of the Somalia famine. Global Food Security, 1(1), 36–42.

    Google Scholar 

  • Maynard, G., & Ong, C. (2016). Economic dependency and HIV/AIDS prevalence in the developing world: a comparative, longitudinal analysis. Sociol Inq, 86(2), 189–216.

    Google Scholar 

  • McCall, L. (2005). The complexity of intersectionality. Signs, 30(3), 1771–1900.

    Google Scholar 

  • McCleary-Sills, J., Douglas, Z., Rwehumbiza, A., Hamisi, A., & Mabala, R. (2013). Gendered norms, sexual exploitation and adolescent pregnancy in rural Tanzania. Reproductive Health Matters, 21(41), 97–105.

    Google Scholar 

  • McIntosh, W. A., & Thomas, J. K. (2004). Economic and other societal determinants of the prevalence of HIV: a testing of competing hypotheses. Sociol Q, 45(2), 303–324.

    Google Scholar 

  • McKinney, L. (2014). Gender, democracy, development, and overshoot: a cross-national analysis. Popul Environ, 36(2), 193–218.

    Google Scholar 

  • McKinney, L., & Austin, K. (2015). Ecological losses are harming women: a structural analysis of female HIV prevalence and life expectancy in less developed countries. Soc Probl, 62, 529–549.

    Google Scholar 

  • Mies, M. (1998). Patriarchy & accumulation on a world scale: women in the international division of labor. New York: Zed Books.

    Google Scholar 

  • Mies, M., & Shiva, V. (1993). Ecofeminism. New York: Zed Books.

    Google Scholar 

  • Mojola, S. A. (2011). Fishing in dangerous waters: Ecology, gender and economy in HIV risk. Soc Sci Med, 72(2), 149–156.

    Google Scholar 

  • Mojola, S. A. (2014). Love, money, and HIV: becoming a modern African woman in the age of AIDS. Oakland: University of California Press.

    Google Scholar 

  • Mosavel, M., Ahmed, R., & Simon, C. (2012). Perceptions of gender-based violence among south African youth: implications for health promotion interventions. Health Promot Int, 27(3), 323–330.

    Google Scholar 

  • Murray, A. F. (2013). From outrage to courage: the unjust and unhealthy situation of women in poorer countries and what they are doing about it. Menlo Park: Anne Firth Murray.

    Google Scholar 

  • Neumayer, E., & Plümper, T. (2007). The gendered nature of natural disasters: The impact of catastrophic events on the gender gap in life expectancy, 1981-2002. Ann Assoc Am Geogr, 97(3), 551–566.

    Google Scholar 

  • Norgaard, K., & York, R. (2005). Gender equality and state environmentalism. Gend Soc, 19(4), 506–522.

    Google Scholar 

  • Ocello, C., Petrucci, A., Testa, M. R., & Vignoli, D. (2015). Environmental aspects of internal migration in Tanzania. Popul Environ, 37, 99–108.

    Google Scholar 

  • Oglethorpe, J., & Gelman, N. (2008). AIDS, women, land, and natural resources in Africa: current challenges. Gend Dev, 16(1), 85–100.

    Google Scholar 

  • Oyefara, J. L. (2007). Food insecurity, HIV/AIDS pandemic and sexual behaviour of female commercial sex workers in Lagos metropolis, Nigeria. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 4(2), 626–635.

    Google Scholar 

  • Pascoe, S. J. S., Langhaug, L. F., Mavhu, W., Hargreaves, J., Jaffar, S., Hayes, R., & Cowan, F. M. (2015). Poverty, food insufficiency and HIV infection and sexual behaviour among young rural Zimbabwean women. PLoS One, 10(1), e0115290.

    Google Scholar 

  • Quinn, T. C., & Overbaugh, J. (2005). HIV/AIDS in women: an expanding epidemic. Science, 308(5728), 1582–1583.

    Google Scholar 

  • Rocheleau, D., Thomas-Slayter, B., & Wangari, E. (1996). Feminist Political Ecology: Global issues and local experiences. New York: Routledge.

  • Sam, A. S., Abbas, A., Padmaja, S. S., Kaechele, H., Kumar, R., & Müller, K. (2019). Linking food security with household’s adaptive capacity and drought risk: Implications for sustainable rural development. Soc Indic Res, 142, 363–385.

    Google Scholar 

  • Shandra, J. M., Shandra, C. L., & London, B. (2008). Women, non-governmental organizations, and deforestation: a cross-national study. Popul Environ, 30(1/2), 48–72.

    Google Scholar 

  • Shircliff, E. J., & Shandra, J. M. (2011). Non-governmental organizations, democracy, and HIV prevalence: a cross-national analysis. Sociol Inq, 81(2), 143–173.

    Google Scholar 

  • Shukla, A. (2014). Drought + politics = famine in Somalia. Int J Innov Appl Stud, 6(4), 1104–1110.

    Google Scholar 

  • Smith, M. K. (2002). Gender, poverty, and intergenerational vulnerability to HIV/AIDS. Gend Dev, 10(3), 63–70.

    Google Scholar 

  • Steinberg, T. (2000). Acts of god: the unnatural history of natural disaster in America. Oxford: Oxford University Press.

    Google Scholar 

  • Stoebenau, K., Heise, L., Wamoyi, J., & Bobrova, N. (2016). Revisiting the understanding of “transactional sex” in Sub-Saharan Africa: a review and synthesis of the literature. Soc Sci Med, 168, 186–197.

    Google Scholar 

  • Terry, G. (2009). No climate justice without gender justice: an overview of the issues. Gend Dev, 17(1), 5–18.

    Google Scholar 

  • Tierney, K. (2007). From the margins to the mainstream? Disaster research at the crossroads. Annu Rev Sociol, 33, 503–525.

    Google Scholar 

  • Tschumi, E., & Zscheischler, J. (2020). Countrywide climate features during recorded climate-related disasters. Clim Chang, 158, 593–609.

    Google Scholar 

  • UNAIDS. (2014). Methodology: understanding the HIV estimates in the OUTLOOK: Cities report. Retrieved from http://www.unaids.org/en/resources/documents/2014/UNAIDS_methodology_cities_report_2014.

  • UNAIDS. (2017). When women lead, change happens. Retrieved from https://www.unaids.org/sites/default/files/media_asset/when-women-lead-change-happens_en.pdf.

  • UNDP. (2016). Climate and disaster resilience. Retrieved from http://www.undp.org/content/undp/en/home/ourwork/climate-and-disaster-resilience/overview.html.

  • UNDP. (2019). Gender Inequality Index. Retrieved from http://hdr.undp.org/en/content/gender-inequality-index-gii#:~:text=The%20GII%20is%20an%20inequality%20index.&text=It%20measures%20the%20human%20development,more%20loss%20to%20human%20development.

  • Wamoyi, J., Wight, D., Plummer, M., Mshana, G. H., & Ross, D. (2010). Transactional sex amongst young people in rural northern Tanzania: an ethnography of young women’s motivations and negotiation. Reprod Health, 7(2), 1–18.

    Google Scholar 

  • Wamoyi, J., Ranganathan, M., Kyegombe, N., & Stoebenau, K. (2019). Improving the measurement of transactional sex in Sub-Saharan Africa: a critical review. J Acquir Immune Defic Syndr, 80(4), 367–374.

    Google Scholar 

  • Warren, K. J. (1990). The power and the promise of ecological feminism. Environmental Ethics, 12(2), 125–146.

    Google Scholar 

  • Weiser, S. D., Leiter, K., Bangsberg, D. R., Butler, L. M., Percy-de Korte, F., Hlanze, Z., Phaladze, N., Iacopino, V., & Heisle, M. (2007). Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Med, 4(10), 1589–1598.

    Google Scholar 

  • Williams, T. P., Binagwaho, A., & Betancourt, T. S. (2012). Transactional sex as a form of child sexual exploitation and abuse in Rwanda: implications for child security and protection. Child Abuse Negl, 36(4), 354–361.

    Google Scholar 

  • Wisner, B. (2016). Vulnerability as a concept, model, metric, and tool. Oxford research encyclopedia of natural Hazard science. Retrieved from: https://oxfordre.com/naturalhazardscience/view/10.1093/acrefore/9780199389407.001.0001/acrefore-9780199389407-e-25

  • World Bank. (2018). World development indicators. Retrieved from https://databank.worldbank.org/data/source/world-development-indicators#.

  • World Health Organization (WHO). (2018). HIV/AIDS. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hiv-aids.

Download references

Author information

Authors and Affiliations

  1. University of Delaware, 18 Amstel Avenue, Newark, DE, 19716, USA

    Virginia Kuulei Berndt

  2. Lehigh University, 31 Williams Drive, Bethlehem, PA, 18015, USA

    Kelly F. Austin

Authors
  1. Virginia Kuulei Berndt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kelly F. Austin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Virginia Kuulei Berndt.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Table 5 OLS regression results with additional control variables
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berndt, V.K., Austin, K.F. Drought and disproportionate disease: an investigation of gendered vulnerabilities to HIV/AIDS in less-developed nations. Popul Environ 42, 379–405 (2021). https://doi.org/10.1007/s11111-020-00367-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11111-020-00367-1

Keywords

Search

Navigation