Rethinking the African AIDS Epidemic

Half the AIDS victims in the world are in East and Southern Africa, where adult HIV sero‐prevalence was 11.4 percent by the end of 1997 and over 25 percent in two countries of Southern Africa. HIV/AIDS infection is not the result of ignorance, as nearly everyone has sufficient knowledge about AIDS and how it is transmitted. The high levels of AIDS arise from the failure of African political and religious leaders to recognize social and sexual reality. The means for containing and conquering the epidemic are already known, and could prove effective if the leadership could be induced to adopt them. The lack of individual behavioral change and of the implementation of effective government policy has roots in attitudes to death and a silence about the epidemic arising from beliefs about its nature and the timing of death. International responsibility may have to be taken before the needed effective policies are put in place.     

Marital Shopping and Epidemic AIDS

HIV risks decline sharply at age 30 for women in South Africa, long before coital frequencies or pregnancies decrease. I evaluate several prominent behavioral models of HIV, and find that these do not suggest sharply decreasing risks with age. I formulate a model of spousal search and find that “marital shopping” can generate epidemic HIV prevalence despite low transmission rates because search behavior interacts with dynamics of HIV infectiousness. The implied age-infection profile closely mimics that in South Africa, and the suggested behavior matches that reported by South Africans. Condom use in new relationships and transmission rate reductions are both found to be effective policies and, when used together, eliminate the potential of spousal search to spread HIV. In contrast, antiretroviral treatment is found to have only a minimal effect on the epidemic.     

On the Socioeconomic Impact of the HIV/AIDS Epidemic

The UN General Assembly Special Session on HIV/AIDS met 25–2 7 June 2001 and adopted a Declaration of Commitment on HIV/AIDS. The Declaration, in 103 paragraphs, sets out a comprehensive response strategy for governments and UN agencies, supports establishment of a global HIV/AIDS and health fund, and calls for an annual progress report to be reviewed by the Assembly. As part of the Special Session, four “round tables” were conducted on substantive topics: prevention and care, human rights, socioeconomic impact, and international funding. Round Table 3, Socioeconomic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS, was led by the United Nations Development Programme. The background document prepared for it is reproduced in full below. It argues that the brunt of the epidemic's impact on human development has been borne by households, communities, and civil society organizations. The emphasis of national and international action has been on prevention and care rather than on counteracting that impact. “Extraordinary efforts” are now required to intensify poverty‐reduction measures, to assist caregivers and orphaned children, to prevent the collapse of public services, and to promote workplace tolerance and flexibility. “While HIV/AIDS must be seen as an emergency of the highest order, steady progress in reducing poverty is still the long‐term and sustainable solution to the health crisis in the developing world. In the long run, prevention and care will only succeed if people and nations can lift themselves out of poverty.” (The Declaration was not much influenced by such arguments. It devotes two paragraphs to socio‐economic impact, both setting diffuse goals: “By 2003, evaluate the economic and social impact of the HIV/AIDS epidemic and develop multisectoral strategies [on poverty alleviation, etc.]” and “By 2003, develop a national legal and policy framework that protects in the workplace the rights and dignity of persons living with and affected by HIV/AIDS.…”) The Millennium Summit referred to in the document was the meeting on the role of the UN in the twenty‐first century held in September 2000 as part of the 55th session of the General Assembly. The Declaration of Commitment on HIV/AIDS and the Round Table 3 document can both be found at http://www.unaids.org/ungass/index.html .     

The HIV/AIDS Epidemic at the End of 1999

The status of the global HIV/AIDS epidemic is summarized in a report entitled AIDS Epidemic Update: December 1999, issued by the United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization. The generally bleak but regionally diverse picture is conveyed in the series of bulleted statements at the beginning of the report and in two summary tables, reproduced below. The rest of the report discusses the regional situations in more detail. An earlier UNAIDS and WHO surveillance report (June 1998) was excerpted in the Documents section of PDR 24 (3).     

The United Nations on the Demographic Impact of the AIDS Epidemic

A report prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and released in Geneva on 27 June 2000 (just prior to the XIIIth International AIDS Conference held in Durban, South Africa) updates estimates of the demographic impact of the epidemic. It characterizes AIDS in the new millennium as presenting “a grim picture with glimmers of hope”—the latter based on the expectation that national responses aimed at preventing and fighting the disease are in some places becoming more effective. According to the report, which emphasizes the considerable statistical weaknesses of its global estimates, the number of people living with HIV/AIDS in 1999 was 34.3 million (of which 33.0 million were adults and 1.3 million were children under age 15; slightly less than half of the adults affected, 15.7 million, were women). Deaths attributed to AIDS in 1999 amounted to 2.8 million, bringing the total since the beginning of the epidemic to 18.8 million. These figures represent moderate upward revisions of earlier UN estimates shown in the Documents section of PDR 25, no. 4. The revised estimate of the number of persons newly infected with HIV in 1999 is, in contrast, slightly lower: 5.4 million, of which 4.7 million were adults and 2.3 million were women. An excerpt from the 135‐page Report on the Global HIV/AIDS Epidemic, focusing on countries in the worst‐affected area, sub‐Saharan Africa, is reproduced below. (Figures shown have been renumbered.)     

The Impact of Family Transitions on Child Fostering in Rural Malawi

Despite the frequency of divorce and remarriage across much of sub-Saharan Africa, little is known about what these events mean for the living arrangements of children. We use longitudinal data from rural Malawi to examine the effects of family transitions on the prevalence and incidence of child fostering, or children residing apart from their living parents. We find that between 7 % and 15 % of children aged 3–14 are out-fostered over the two-year intersurvey period. Although divorce appears to be a significant driver of child fostering in the cross-sectional analysis, it is not significantly associated with the incidence of out-fostering. In contrast, maternal remarriage has both a lagged and an immediate effect on the incidence of out-fostering. Furthermore, the likelihood of out-fostering is even higher among children whose mother remarried and had a new child during the intersurvey period. Using longitudinal data collected from living mothers rather than from children’s current foster homes offers new insights into the reasons children are sent to live with others besides their parents.     

社会性别化的风险、经历与反应——对美国妇女与艾滋病的探讨

艾滋病目前已成为美国一个严重的社会问题和大众健康问题。妇女从 2 0世纪 80年代在边缘徘徊 ,到 90年代已陷入了该危机的“震中”。本文将从女权主义的视野来审视这场社会性别化的传染病 ,即把社会性别当作主要变量来考察它同种族、族裔、阶级、性取向以及文化等诸因素的交叉互动 ,并从纷繁复杂的艾滋病现象和文献中梳理出妇女与艾滋病关系上的社会性别差异。文章最后将提出若干可资借鉴并值得我们警觉的建议     

Developmental Idealism and Cultural Models of the Family in Malawi

This paper examines the extent to which developmental idealism has been disseminated in Malawi. Developmental idealism is a set of beliefs and values about development and the relationships between development and family structures and behavior. Developmental idealism states that attributes of societies and families defined as modern are better than attributes defined as traditional, that modern societies help produce modern families, that modern families facilitate the achievement of modern societies, and that the future will bring family change in the direction of modernity. Previous research has demonstrated that knowledge of developmental idealism is widespread in many places around the world, but provides little systematic data about it in sub-Saharan Africa or how knowledge of it is associated with certain demographic characteristics in that region. In this paper, we address this issue by examining whether ordinary people in two settings in Malawi, a sub-Saharan African country, have received and understood messages that are intended to associate development with certain types of family forms and family behaviors. We then examine associations between demographic characteristics and developmental idealism to investigate possible mechanisms linking global discourse about development to the grassroots. We analyze data collected in face-to-face surveys from two samples of Malawian men in 2009 and 2010, one rural, the other in a low-to-medium income neighborhood of a city. Our analysis of these survey data shows considerable evidence that many developmental idealism beliefs have been spread in that country and that education has positive effects on beliefs in the association between development and family attributes. We also find higher levels of developmental idealism awareness in the urban sample than we do in the rural sample, but once dissimilarities in education and wealth between the two samples are controlled, awareness levels no longer differed between urban and rural respondents. We explore how these beliefs intersect with longstanding local values and beliefs in Malawi.     

Demographic response to environmental pressure in Malawi

The discussion in this paper uses Malawi as a case study to shed some light on the interrelationships between population growth and demographic responses to environmental pressure. It is noted that certain parts of the country that are experiencing extreme environmental stress have began to go through a rapid phase of demographic and social change and transformation. For example, the Southern Region of the country, which has some of the highest densities, is experiencing a fertility transition. There is a spontaneous internal migration pattern from densely populated rural areas to other sparsely populated rural areas. Other non-demographic responses to population pressures are also briefly discussed in this paper.     

Navigating Islam and same-sex liaisons among men in Turkey

This study reports the experiences of 20 Turkish men in having sex with men in an Islamic society. As part of a broader study on Turkish homosexualities, the article analyzes responses to the question, "What joys and difficulties have you experienced regarding your sexual orientation in relation to Islam?" to elicit responses on how Islam and homosexuality might coexist in everyday life.     

Navigating Islam and Same-Sex Liaisons Among Men in Turkey

ABSTRACT

This study reports the experiences of 20 Turkish men in having sex with men in an Islamic society. As part of a broader study on Turkish homosexualities, the article analyzes responses to the question, “What joys and difficulties have you experienced regarding your sexual orientation in relation to Islam?” to elicit responses on how Islam and homosexuality might coexist in everyday life.     

Using innovation to address HIV, AIDS, and environment links: intervention case studies from Zimbabwe, Uganda, and Malawi

This article presents three cross-cutting intervention case studies that address HIV, AIDS, and natural resources management in an integrated manner through innovative programming in Zimbabwe, Uganda, and Malawi. In Zimbabwe, a religious-based non-governmental group and two community organizations work together to build skills of HIV- and AIDS-vulnerable children in rural areas to meet dietary and income needs, while using natural resources sustainably. In Uganda, various government agencies and NGO actors work together to improve the food security of HIV-affected households at the national, district, sub-district, and village levels. Finally, in Malawi, a conservation organization incorporates HIV and AIDS awareness and programming into its operations and projects. Each case study presents pioneering approaches to simultaneously addressing the pressures on conservation initiatives, food security/agricultural production, income generation/livelihoods, and social and health care systems. They also provide lessons for expanding interventions and partnerships.     

Environmental Change,Risky Sexual Behavior,and the HIV/AIDS Pandemic: Linkages Through Livelihoods in Rural Haiti

Local natural resources are central to rural livelihoods across much of the developing world. Such “natural capital” represents one of several types of assets available to households as they craft livelihood strategies. In order to explore the potential for environmental scarcity and change to contribute to perpetuation of the HIV/AIDS pandemic, we examine the association between declining natural capital and engaging in risky sexual behaviors, as potentially another livelihood strategy. Such an association has been demonstrated in Kenya and Tanzania, through the fish-for-sex trade. To explore the possibility of this connection within rural Haitian livelihoods we use Demographic and Health Survey data, with a focus on rural women, combined with vegetation measures generated from satellite imagery. We find that lack of condom use in recent sexual encounters is associated with local environmental scarcity—controlling for respondent age, education, religion and knowledge of AIDS preventive measures. The results suggest that explicit consideration of the environmental dimensions of HIV/AIDS may be of relevance in scholarship examining factors shaping the pandemic.     

The evolution of population policies in Kenya and Malawi

Our case studies of the evolution of population policies in Kenya and Malawi offer insights into the interaction between the global population movement and national governments. The comparison is useful because it permits identifying the common strategies of a global movement, strategies that are likely to be evident elsewhere; it also permits identifying differences in national responses related to particular domestic contexts. We find a common repertory of movement strategies to influence the governments of Kenya and Malawi to adopt a neo-Malthusian population policy and to implement a family planning program. However, these strategies were promoted more or less aggressively depending on the national response and the chronological period. National responses were related to differences in the governments approaches to nation-building, their willingness to accept foreign influence and the importance they placed on preserving cultural traditions, and to their assessment of benefits they would gain from responding favorably to movement proposals. The data come from written accounts and from interviews with international actors and Kenyan and Malawian elites who participated in the policy development process.     

Including the Smoking Epidemic in Internationally Coherent Mortality Projections

We present a new mortality projection methodology that distinguishes smoking- and non-smoking-related mortality and takes into account mortality trends of the opposite sex and in other countries. We evaluate to what extent future projections of life expectancy at birth (e ₀) for the Netherlands up to 2040 are affected by the application of these components. All-cause mortality and non-smoking-related mortality for the years 1970–2006 are projected by the Lee-Carter and Li-Lee methodologies. Smoking-related mortality is projected according to assumptions on future smoking-attributable mortality. Projecting all-cause mortality in the Netherlands, using the Lee-Carter model, leads to high gains in e ₀ (4.1 for males; 4.4 for females) and divergence between the sexes. Coherent projections, which include the mortality experience of the other 21 sex- and country-specific populations, result in much higher gains for males (6.4) and females (5.7), and convergence. The separate projection of smoking and non-smoking-related mortality produces a steady increase in e ₀ for males (4.8) and a nonlinear trend for females, with lower gains in e ₀ in the short run, resulting in temporary sex convergence. The latter effect is also found in coherent projections. Our methodology provides more robust projections, especially thanks to the distinction between smoking- and non-smoking-related mortality.     

AIDS in China

Although 10,676 people were officially reported to be infected with HIV on China's mainland by the end of June 1998, experts estimate that more than 300,000 Chinese are actually infected with HIV in China. They also believe HIV continues to spread in alarming fashion. Two thirds of reported HIV infection cases live in rural China, and nearly one third of the 301 people diagnosed as having AIDS have died. About 10% of all HIV infections occurred among teenagers under age 19 years old, with most infected through IV drug use. 60% of teens who responded to a survey in 1997 did not possess correct basic knowledge about AIDS, and 21% did not know how to protect themselves from contracting HIV.     

AIDS in China

Most recent official statistics indicate that there was a cumulative total of 133 AIDS cases in mainland China through the end of October 1996 and 5157 people infected with HIV. Official statistics also indicate continuing increases in recent years in the number of people with AIDS and people infected with HIV, and that the incidence of infection is growing in China. HIV has been found to have been transmitted in China through IV drug use, sexual activities, from mother to child, and through transfusions and the use of blood products. Important risk factors for the spread of HIV in China include high population density, a considerable transient population, drug use, prostitution, blood transfusion, the improper sterilization of medical instruments in rural areas, changes in people's sexual attitudes and behaviors, and lack of information on safe sex. The Chinese government reports having taken considerable steps to check the spread of HIV/AIDS and supports communication and education as an essential tool in the fight against the epidemic. Life expectancies in China's provinces and municipalities are listed.     

Health Selection,Migration, and HIV Infection in Malawi

Despite its importance in studies of migrant health, selectivity of migrants—also known as migration health selection—has seldom been examined in sub-Saharan Africa (SSA). This neglect is problematic because several features of the context in which migration occurs in SSA—very high levels of HIV, in particular—differ from contextual features in regions that have been studied more thoroughly. To address this important gap, we use longitudinal panel data from Malawi to examine whether migrants differ from nonmigrants in pre-migration health, assessed via SF-12 measures of mental and physical health. In addition to overall health selection, we focus on three more-specific factors that may affect the relationship between migration and health: (1) whether migration health selection differs by destination (rural-rural, rural-town, and rural-urban), (2) whether HIV infection moderates the relationship between migration and health, and (3) whether circular migrants differ in pre-migration health status. We find evidence of the healthy migrant phenomenon in Malawi, where physically healthier individuals are more likely to move. This relationship varies by migration destination, with healthier rural migrants moving to urban and other rural areas. We also find interactions between HIV-infected status and health: HIV-infected women moving to cities are physically healthier than their nonmigrant counterparts.     

Migration,Marital Change,and HIV Infection in Malawi

Research on the relationship between migration and HIV infection in sub-Saharan Africa often suggests that migrants are at higher risk of HIV infection because they are more likely to engage in HIV risk behaviors than nonmigrants, and they tend to move to areas with a relatively higher HIV prevalence. Although migration may be a risk factor for HIV infection, I instead focus on the possibility that the HIV positive are more likely to migrate. Using a longitudinal data set of permanent rural residents and migrants from Malawi, I find that migrants originating from rural areas are indeed more likely than nonmigrants to be HIV positive and to have engaged in HIV risk behaviors. The increased HIV risk among migrants may be due to the selection of HIV-positive individuals into migration; I find that HIV-positive individuals are more likely to migrate than those who are HIV negative. The explanation for this phenomenon appears to be marital instability, which occurs more frequently among HIV-positive individuals and leads to migration after marital change.