The high incidence of AIDS in Africa

Sub-Saharan Africa suffers from the highest rates of AIDS infection in the world. Southern African countries are dealing with the worst of it, with infection rates of 20-30 percent.

So what are the most problematic mechanisms of transmission in these countries, i.e. the mechanisms that are causing the most new cases?

-Mother-to-child (during birth)?

-IV drug use with shared needles?

-Male homosexual intercourse?

-Prostitution?

-Other???

More directly: what’s happening there (to cause high AIDS incidence) that isn’t happening in the developed world?

That Wikipedia article mentions a couple of factors, and it sounds like the biggest problem is that a lot of people are having sex with many partners and not using condoms. It also cites a lack of medicines (in addition to prolonging survival, drugs can prevent an HIV-infected mother from spreading the disease to her child), along with prostitution in Eastern Africa.

From time to time you see news stories alleging that men in Africa believe they will be cured of HIV or AIDS if they have sex with a virgin, leading to rapes (and to further transmission of the disease). I don’t know how widespread that belief really is, or how often those assaults may happen.

I do not have answers for the questions, but I am curious as to why you specifically singled out both male and homosexual intercourse when HIV can be transmitted via sexual intercourse of any sort? The idea that HIV is a gay thing, besides being patently false, went out with the 80s.

I’d say the largest factor has to be poverty. Also, a great deal of socio-political unrest, leading to a weakening of social mores, and of course rapes.

And yes, I meant to ask about the “male homosexual” thing too.

Wars don’t help, though there’s more a central African thing than south African, these days. There aren’t many militaries in central Africa that have strong norms against inflicting outrages upon civilians.

The two main factors:

1)Male heterosexual promiscuity.
Of course there are promiscuous females too, but there are fewer in the societies we are discussing and those may be prostitutes in one form or another.

2)Reluctance to use condoms. Sometimes for religious reasons, but not always.

Low education rates, poor economy and strife have created a society where men are very protective of their masculinity and using a condom is not manly in their eyes. I can’t say exactly why, something about stopping them from spreading their seed or spirit or whatever their ignorance has led them to believe. Even in america, in disadvantaged fringes of society, each child, with one woman or multiple, is a proof of virility - even if you can’t afford to support it.

Promiscuity is another way they prove their masculinity.

Homosexuality: In some subsaharan cultures, Homosexual acts are only considered “gay” for the bottom. Topping someone is also a manly display of masculinity and the topper is not considered a homosexual.

And to the ignorant, rape of either gender is an act of conquest. In South Africa, something like 25% of men admitted to commiting rape.

I apoligize if my choice of words raised the spectre of homophobia. Unprotected anal intercourse is what I was thinking of.

While you are correct in that AIDS can be transmitted via sexual intercourse of any sort (and also via several non-sexual means), my understanding is that due to the fragility of the anus/rectum, unprotected anal intercourse presents considerably greater risk of transmission than other sexual activities, particularly for the receiving partner.

Furthermore, while it is true that anal intercourse is not exclusively the domain of homosexual men, my speculation is that it is far more prevalent among that group than among heterosexual couples or homosexual women. I welcome correction if you think I’m way off base here.

Multiple heterosexual partners, usually combined with migrant/transitory labour like mineworkers & truckers. So a guy will go work on a mine far from his tribal homeland, sleep with prostitutes there, get HIV, then take it home to his wife. And people come to work on Southern African mines from all over the subcontinent.

See the movie Yesterday for a wife’s-eye view of the situation.

Yes. Cecil addressed this in 1988, in “What are the odds of getting AIDS from ordinary heterosexual sex?”

When you look at the promiscuity, lack of condom use, social unrest, and lack of medicines, I don’t see why anal intercourse would be a factor. You asked what’s happening in Southern Africa that’s not happening in the West that is spreading AIDS, and anal intercourse does happen here.

Vaginal intercourse is a bigger risk for HIV transmission (from man to woman or woman to man) when other STDs are present, which is much more common in Africa, due to poverty and lack of medical care.

You left out the important word, “unprotected.” If condoms aren’t routinely available in Africa, or are eschewed for cultural reasons as pan1 suggested, that could make a big difference in transmission rates.

Ultimately I suppose the nature of the individual sexual activity is less important than the habit of promiscuity. If the “Yesterday” movie mentioned by MrDibble is representative, then unprotected sex (of any kind) with multiple partners (whether gay or straight) is a major part of the problem.

I have also read that, for some cultural reason, many men prefer ‘dry’ vaginal sex, which leads to abrasions and easier transmission.

Another thing to remember is that the spread of any disease is not linear. When more people have it, it spreads to the remainder of the population faster. If 1% have a disease and each contributes to one new case in a certain period of time, 2% will have it. But it 10% have the disease, then in the same period of time, it will spread to about 20% of the population. The spread eventually has to slow as there are fewer and fewer left to contract the disease.

On the brighter side, because of the huge proportion of people with HIV in Africa, we’ve been able to identify that there are some people with Immunity - at least to some strains.
http://www.accessexcellence.org/WN/SUA04/natural_immunity_HIV.php

Additional factors once a person has been infected with the virus that leads to quicker death is not only lack of medicine (cost), but also widespread malnutrition in poorer population, which means weaker bodies and immune system. Some experts say that many sick in hospitals are generally weak and might or might not have AIDS. Even the tests are too expensive and difficult to administer in those rural areas, so they assume everybody who’s in bad shape has AIDS, but can’t confirm it.

In a book on the effect of the black plague in Europe, a sidenote was a tentative conclusion that a difference in genome in Europeans was the result of surviving the plague by being resistant due to a genetic mutation. The modern Africans don’t have that mutation, and that might be the explanation for higher rates of transmission for certain strains of AIDS in Africa vs. Europe, even accounting for all the enviromental factors mentioned above, that the old genetic mutation also confers resistance to some (not all) strains of AIDS to Europeans.

This was couched in very careful terms and with cautions of “needs more research” to avoid the impression that the Africans can’t be helped because they will get AIDS anyway or other misguided interpretations people with an agenda might twist from this.

As for the belief about curing AIDS by raping little girls - charity organisations are regularly reporting about this, esp. in South Africa. Some years ago, a prominent South African politican, a minister for sth. or other, publically announced that the whole information campaign about AIDS was a conspiracy from Whites/Europeans/the US/CIA to suppress the South Africans, and that sleeping with a virgin could cure it. Raping little schoolgirls is the only way to be sure of virgin status for many of the men who believe that. (The charities involved in the information campaigns were upset, of course, but the damage was done).

Prostitution

There doesn’t seem to be a whole lot of social stigma attached to visiting prostitutes , particularly by teamsters who can seed their disease all over the country into prostitutes who can seed their disease all over their local populations.

Yes, it could make a difference. I’m suspect it’s a few places down the list, however.

The numbers on AIDS are not based on tests, they are based on symptoms. This is very hard to detect accurate numbers.

If you go to the WHO Website you find:

Without getting into a big thing, you cannot compare how they diagnose AIDS and HIV in Sub-Sahara Africa as in Western countries where they actually test you.

It could be off either way. The numbers are only as good as the sample. Plus Africans are very stigmatized by AIDS, so many doctors simply don’t put AIDS as a cause of death. Like Malaria which is endemic in Sub-Sahara generally will infect 90% of Sub-Sahara Africans in some form or another. If the person has AIDS and Malaria and dies of Malaria, they write Malaria on the death certificate.

Male-male intercourse, for sure. In many many African cultures & societies, surveying the populace on guy-guy sex is like polling them on Star Trek vs. Star Wars. What on earth are you talking about, Western Person?

If they won’t acknowledge it, you can’t much do anything about it.

It’s been mentioned, but I read an article in Discover a couple years ago about the social structures there. As noted, most men have regular sexual relationships with more than one woman; many women are similarly polyamorous. This is in fact much more conducive to the spread of disease than just prositution, where a guy has a wife, but from time to time steps out on her with anonymous others. Say a man having unprotected vaginal intercourse with an infected woman has a 10% chance of getting the bug. Well, that’s bad enough, but if instead the infected woman is one of three women that he sleeps with a dozen of times in a given year, then he probably will get it. And within the year, so will the other two women. And, within the next year, so will the one or two other men that they regularly sleep with. And so on. When the bug gets into the network, it spreads like wildfire in the network.

–Cliffy