Question

Explain the link between poverty and HIV/AIDS.

Answer 1

HIV/AIDS continues to cut into the fabric of African households and societies. It is not uncommon to hear that a quarter to a third of the adult population in several African countries are HIV infected. Against this reality of a rapidly spreading epidemic, some two decades of prevention interventions have met with but limited success. Whatever successes there might be are not to be lightly dismissed. The reasons for those successes, however, are not well understood and thus not readily applicable elsewhere. To date, most prevention efforts have focused on increasing individual awareness about risks of transmission and promoting individual risk reduction through a variety of means.

Far less attention has been given to either understanding or designing prevention programs in light of the social and economic context in which individuals live. It is commonplace for HIV/AIDS program managers to acknowledge poverty as a causative factor, but to then say that "poverty" is beyond the scope of their programs. Instead, top-down analyses and decisions about prevention have shaped public health responses. While the urgency spawned by an epidemic often requires quick decisions and implementation, and while the HIV/AIDS epidemic is of urgent concern in many countries and to many social groups, HIV/AIDS is now too pervasive and too deeply embedded in society to be "managed" through top-down public health approaches alone. Placing the epidemic within the context of a set of development issues and drawing upon the resources and experiences of local initiatives might at first appear to step back from the urgency demanded by an epidemic; in fact, it is the only effective response.

Poverty and HIV/AIDS

Poverty is a key factor in leading to behaviors that expose people to risk of HIV infections. The United Nations Development Program, for example, argues that poverty aggravates other factors that heighten the susceptibility of women:

"A lack of control [by poor women] over the circumstances in which the intercourse occurs may increase the frequency of intercourse and lower the age at which sexual activity begins. A lack of access to acceptable health services may leave infections and lesions untreated. Malnutrition not only inhibits the production of mucus but also slows the healing process and depresses the immune system."

The relationship between poverty and HIV/AIDS is "bi-directional":

* Poverty is a factor in HIV transmission and exacerbating the impact of HIV/AIDS.

* The experience of HIV/AIDS by individuals, households and even communities that are poor can readily lead to an intensification of poverty and even push some non-poor into poverty. Thus HIV/AIDS can impoverish or further impoverish people in such a way as to intensify the epidemic itself.

The extent of impoverishment in the world today is truly staggering. According to an internationally adjusted standard of absolute poverty, sub-Saharan Africa has four times as many poor people as non-poor. 1.2 billion persons are forced to live on less than one dollar a day. Poverty and gender are inextricably intertwined. Women and girls are disproportionately represented among the poor. Seventy percent of the world's poor are women. It is poor women who are most susceptible to HIV infections, for gender alone does not define risk.

When we call people "poor" we are in danger of forgetting that they are made poor. Poor people are really impoverished people. They are impoverished by inequitable socioeconomic structures on the household level, on the village level, on the national level, and on the international level of trade and commerce. This becomes clear as we look at AIDS as one in a series of "shocks" experienced by the majorities of people in developing countries.

Poverty, Migration and HIV

The epidemiological relationship between migration and HIV is well established. A study in Senegal found that 27 percent of the men who had previously traveled in other African countries and 11.3 percent of spouses of men who had migrated were infected with HIV. In neighboring villages where men had not migrated less than one percent of the people were HIV positive. High HIV prevalence rates in areas of high out-migration have been documented in Mexico, Senegal, Ecuador, and in the south-east of Ghana. Rural communities in West Africa known for out migration (mostly to the southern areas of Cote d'Ivoire) such as the area of Tambacounda in Sengeal, Sikasso in Mali, the district of Manya Krobo in Ghana, the area of Mono in Benin and the Otukpo Local Government Area in Nigeria are recording HIV infection rates two to three times that of the national rates. Using 1993 data, a