AIDS in Africa: the implications of economic recession and structural adjustment

In Africa where 80% of acquired immunodeficiency syndrome (AIDS) cases are attributable to heterosexual intercourse or vertical transmission it has been assumed that infection flows from a core group of highly sexually active prostitutes to moderately promiscuous male clients and finally to relatively monogamous women of childbearing age. This assumption has led to an emphasis on modifying the behavior of individual prostitutes rather than addressing the structural factors that underlie the AIDS crisis. The latter factors include womens subordinate status in African society the disruption of rural families created by the migrant labor system and inadequate health services. Faced with few employment options many urban African women are forced to engage in prostitution to support themselves and their children. Moreover their low socioeconomic status hinders their ability to insist that male clients use condoms--the major strategy of African AIDS prevention programs. The recent economic crisis has exacerbated all these problems by increasing the population at risk through the pathways of urban migration poverty and prostitution and cuts in health services. It is essential that government initiatives go beyond the promotion of "safe sex" and confront fundamental structural issues such as the migrant labor system and womens status. Also needed is a critical reassessment of the assumption that African males are more promiscuous than males in other cultures. Biological factors such as genital ulcers and other sexually transmitted diseases may make African men and women more susceptible to contracting the AIDS virus in a single sexual encounter than their counterparts in other countries.