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POVERTY
Patterns of sexual networking alone did not exacerbated the spread of AIDS in Africa. The continent’s high poverty has certainly accelerated its proliferation across its 52 countries from rural Kenya to metropolitan Burkina Faso. The majority of Africans do not have the monetary means to protect themselves; many cannot afford condoms or antibiotics to treat other kinds of STDs which are frequently common in Africa. An important AIDS-related implication of this is that a person’s risk for HIV increases significantly if they have a genital discharge or ulcers; genital discharge and ulcers create open sores and inflamed mucosal surfaces that enables the virus to enter the body more easily.

   Poverty creates financial constraints and limitations that forces poor people to undertake dangerous jobs (Nguyen). Many African women, having little choice and no employment opportunities, resort to prostitution. The risk for HIV infection increases in situation where clients will offer more money for unprotected sex; in most cases, the women will habitually agree. Numerous studies found that African women’s survival strategies were largely dependent on the exchange of sexual favors (Turshen). In some countries such as Mozambique and Malawis, evidence suggests that war and poverty have a gender-specific effect; many men who have died during the war leave their wives behind to head the households. Many have lost most of their wealth and/or primary source of income (i.e. husbands) and find themselves unable to provide for the households (which usually includes children, husband’s parents, unemployed brother…) and thus, participate in the growing economy of prostitution in order to create much needed income.

CULTURAL PRACTICES
In Western cultures, the prevention of AIDS infection has been more effective due to various factors: individuals are more educated and literate, people have more knowledge, better access to health and economic resources, better employment, a higher standard of living, and so forth. In addition, Western culture is predicated on a model of equalitarian relations where women have as much, if not, equal rights as their male counterparts. Decades ago, it was the man who took care of ‘protecting’ both himself and his partner in terms of contraceptive methods and disease prevention. In modern times, women now take care of these concerns; it is no longer uncommon for Western women to purchase condoms and demand that their partners use them otherwise forgo sexual relations. In Africa, this is not the case for women; the weight of customs makes it difficult and almost impossible for many African women to insist that their boyfriends or husbands use them. African women have little bodily autonomy. In fact, African women have little autonomy at all since the majority of them are greatly dependent on their husbands, fathers, brothers or other male counterpart for financial subsistence and survival.

   There are a number of cultural practices that have aided in the proliferating spread of AIDS. In some areas, men are bounded by kinship obligations to marry and provide for their deceased brother’s widow. If the man’s death was caused by AIDS, the extension of sexual relations from his widow to his brother who in turn also engage in sexual relations with his own wife, will pass the virus from one infected person to the next.

   Other cultural practices include male circumcisions with unsterilised razors and blades and to rites of male passage and bonding where ritual scars are cuts on people’s cheeks. In recent years, there has been an increase in child rape in South Africa attributed to the myth that a man can rid himself of HIV by sleeping with a virgin.

SUBORDINATE POSITIONS OF WOMEN
Sexism kills, just as surely as--and combined with--racism. In Africa, traditional oppression of women has meshed with new, profit-driven forms of oppression. In southern Africa, married women often don't dare ask their husbands to wear condoms, and are pressured by relatives to stay unprotected for maximum fertility. Husbands are expected to have many sex partners while their wives are expected to be monogamous. This subordinate position of African women is ruled by the primary fact that most African women are dependent on their husbands to provide financial support for them; African women are bounded to this type of relationship as long as she continues to depend on her husband’s economic support. African women are forced to endure the polygamous relationship of her husband so long as they require his financial contribution (Turshen). This economic dependence compounds women’s dependency on men and influence women’s ability to request or negotiate safer sexual practices (Bujra & Baylies).

   Women’s vulnerability to HIV and their sexual and reproductive health status are centrally related to life within the context of a patriarchal society. The dominance of men pervades every aspect of African women’s lives: family, society, religion, the law and institutions all negatively affect women’s ability to be assertive and protect herself. Most women in African communities accept that their husbands or partners have other sexual partners, and because of a lack of education and skills women have been forced to become and remain “sexual slaves” to their men.

WARS
Another factor that facilitated the spread of AIDS is Africa’s endless wars and political uprisings. Soldiers are regularly employed in large part due to the continual political wars and as such, enjoy regular pay allowing them greater opportunity to buy sex. Wars – with its inevitable underpinnings of violence – carries acts of violence, with rape being a common occurrence. Lieutenant General John Koech, deputy chief of the Kenyan general staff declared that “between 50-60% of beds at the Forces memorial Hospital in Nairobi were now occupied by AIDS/HIV sufferers.” (BBC News) In 2000, the civil war in the democratic republic of Congo involved at least 14 separate armies and rebel factions of which almost half were estimated to be HIV-positive. The devastation that these wars produce are double-edged; deaths and rapes are a highly-visible source of devastation but not so visible nor evident, is the propagation of the virus from the HIV-infected soldiers to their unwilling recipients.

MIGRANT LABOUR
The lack of employment opportunities affect both men and women in Africa; while women prostitute themselves to supplement their livelihood, African men are forced to leave their homes and families for an inordinate amount of time and travel far to work in gold mines or as truck drivers. Such prolonged displacements tend to destabilize sexual relationships and helps spread the virus; many miners are separated by their wives for extended periods of time and may sleep with prostitutes to alleviate their sense of loneliness, for companionship or simply, for physical comfort (Crush & James). African mineworkers lead isolated, alienated and often violent lives. They are cut off from the broader society and their families working in an industry that demands a lot from them but yet give back so little (Crush & Williams). The life of the migrant mineworker is frequently an abrasive one in which the stresses of a dangerous and taxing job are exacerbated by the alienation of living away from home and family. These strains have a negative effect on the health of the migrant worker; several studies have revealed a positive correlation between psychological strains, social strains, and job stress. Other health outcomes produced by theses various stressors include: high blood pressure, diabetes, cardiovascular diseases, and the development of peptic ulceration.

   Apart from the stresses of underground mining (i.e. tough working conditions – combination of excessive heat, noise, humidity that causes discomfort, anxiety and fear) and of labour and human relations (i.e. lack of respect from seniors, little or no prospect of promotion, threat of retrenchment, boredom, sense of exploitation, unfair compensation), mineworkers have the added experience of social stress. The industry of mining often appeals to migrants who have no schooling background and thus represent one of the few employment opportunities open to them. In addition, in African countries, the issue of kinship relations place a great financial burden on the migrant miner to provide monetary support to not only his immediate family (i.e. wife and children) but also other members of the household (e.g. his parents, an unmarried sister, an unemployed brother and their children).

   With the removal of influx control laws, thousands of African men and families have moved away from the impoverishment of rural areas to seek a better life in and near the urban centres; the bitter reality for many Africans is that there is no better life because too few jobs existed. In addition, the government’s policy adoption of a free market approach to housing translated to an abolishment of state-owned housing which in turn, meant that people fleeing rural poverty had no housing available to them.
The result is an emergence of huge squatter communities throughout the country marked by excessive overcrowding, a lack of sanitation, poor nutrition and hunger resulting in a high level of disease outbreaks. Migrant labour and family separation, combined with high levels of background infections have facilitated the transmission and progression of HIV. A study of HIV in KwaZulu/Natal in 1990 revealed that among people within the 15-44 year age group, those who were most mobile (defined as having moved once in the previous year) had nearly three times the incidence of HIV infection compared with their more stable counterparts.

CONCLUSION
Current AIDS awareness and prevention campaigns in Africa target men and women with messages of safer-sex – such as the use of condoms, monogamy, non-penetrative sex, reduction in number of partners, celibacy, and treatment of STDs - seldom, are successful. An important reason attributable to the failure of such AIDS prevention campaigns is that such campaigns are predicated on the assumption that all is equal between partners in sexual interactions but rarely it this the case.

   Cultural explanations and perceptions of illness, disease and well-being – as understood by local communities – must also be factored in. Both are crucial in the sense that individuals’ views, attitudes and socio-economic reality will determine their behaviors in terms of a model of preventative health as opposed to a simplistic health model of treatment and compliance. In regards to AIDS, a model of preventative health is required to ensure that the disease be contained and to avoid a historical repeat of an epidemic population wipeout as that of the Bubonic Plague which killed over 25 million people in Europe within five years only. A health model of treatment and compliance should not be the focus and goal regarding AIDS intervention in Africa insofar that there exist no present vaccine and cure for the virus. A model of health treatment is ineffective, unproductive and without medical rationale if it discounts socio-economic factors such as poverty and structural and gender inequalities.

   If interventions around are to be effective, they must address the factors which drive the epidemic. Such factors are deep-seated and intransigent, embedded in the very political, cultural and economic context which define the behavioral responses towards such intervention programmes.

References:
Baylies, Carolyn and Janet M. Jujra. 1999. “ Solidarity and Stress: Gender and Local Mobilization in Tanzania and Zambia.” In Families and Communities Responding to AIDS, ed. Aggleton, Peter, Graham Hart and Peter Davies, eds. 35-52. New York: UCL Press.
Chapman, Rachel, Julie Cliff and Rosa Marlene Manjate. 2000. “ Lovers, Hookers, and Wives: Unbraiding the Social Contradictions of Urban Mozambican Women’s Sexual and Economic Lives.” In African Women’s Health, ed. Meredeth, Turshen, 49-68. Trenton: Africa World’s Press, Inc.
Crush, Jonathon and James, Wilmont, eds. 1995. Crossing Boundaries: Mine Migrancy In A Democratic South Africa. Ottawa: International development Research Centre.
Guest, Emma. 2003. Children of AIDS: Africa’s Orphan Crisis. London: Pluto Press.
Kuate-Defo, Barthйlйmy. 1998. Sexuality and Reproductive Health During Adolescence in Africa. Ottawa: University of Ottawa Press.
Nguyen, Vinh-Kim. “Ties That Might Heal: testimonials, Solidarity and Antiretrovirals in West Africa.” An Introduction To Medical Anthropology: Selected Readings, ed. Sandra Hyde, 403-437.
Williams, Olufemi A. 1991. AIDS: An African Perspective. Boca Raton: CRC Press.

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