Political economy and social epidemiology in the context of the HIV epidemic in sub-Saharan Africa

Deane, Kevin (2024). Political economy and social epidemiology in the context of the HIV epidemic in sub-Saharan Africa. In: Primrose, David; Loeppky, Rodney and Chang, Robin eds. The Routledge Handbook of the Political Economy of Health and Healthcare. Routledge International Handbooks. Abingdon: Routledge, pp. 190–201.

DOI: https://doi.org/10.4324/9781003017110-17

Abstract

This chapter provides some critical reflections on epidemiology and social epidemiology and the application of risk-factor social epidemiology to the social determinants of health. Whilst there have been significant methodological advances within the field of social epidemiology, the risk-factor approach still dominates. Using a case study of migration, population mobility and HIV in sub-Saharan Africa, this chapter illustrates some of the limitations of this approach when applied to the structural drivers of HIV. These limitations include an inherent methodological individualism which is at odds with the social determinants of health, the need for complex social phenomena to be captured in a reduced form by variables that can be incorporated into statistical analyses, and the extent to which variables like ‘being mobile’ are treated in the same way as exposure, such as having unprotected sex. The result is an expanding literature that reports results that are often inconclusive and contradictory, leading to few firm conclusions regarding to what extent mobility is a risk factor for HIV and for whom. The social epidemiological approach is contrasted with a political economy approach that emphasizes the need to locate the relationship between population mobility and HIV within the dynamics of contemporary capitalism, and the experiences and working conditions of mobile populations

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