The social epidemiology of Africa's AIDS epidemic
Larson, A.
African Affairs 89(354): 5-25
1990
ISSN/ISBN: 0001-9909 DOI: 10.2307/722494Document Number: 328910
The paper considers the present status of AIDS in Africa, concentrating on heterosexual transmission, which is responsible for 80%-85% of transmission in Africa. In some regions of the continent prevalence levels of HIV infection are high. There are shortcomings in the seroprevalence data but published findings are used to identify where the epidemic is extensive, where it has recently begun, and where it is spreading slowly. As complete a picture as possible is presented of the geographic distribution of HIV prevalence in the general adult population in 1987. Demographers have recently estimated that 0.9% of the total population aged 15-49 in Africa was infected with HIV. The estimated prevalence for sub-Saharan Africa alone would be 1.1% of the adult population. Applied to the total population, the estimates suggest that 2.5 million persons are already infected, which accords with the WHO estimate for Africa of 2 to 3 million. The epidemiological 'facts' about HIV infection in Africa are usually generalizations based on one or two inadequately reported studies. Among the most common statements are: women are infected as often as men; the continent's elite are disproportionately affected; and only the promiscuous are at risk. These generalizations are no longer supported by unambiguous evidence. The continent certainly suffered tragic misfortune in being exposed to HIV before many other parts of the world. However, features of African social life encourage multiple sexual partners and frequent partner changes that make Africans especially vulnerable to a deadly sexually transmitted disease. The spread of HIV is still largely determined by the historical development of sexual relations in towns and cities and the sexual ties between urban and rural areas, reinforced by male-dominated urban migration and economic hardship.