‘Poverty Causes AIDS’ Assumption Blocks Full Picture
Although it has become "popular to ascribe the main cause of the AIDS pandemic in developing countries to poverty," University of California-San Francisco medical anthropologist and public health consultant Daniel Halperin writes in Global Health Council's AIDSLink, the "well-meaning expression [of] 'poverty causes AIDS' ... [may] do more harm than good by inadvertently encouraging a fatalistic attitude in the face of HIV's continuing spread." Despite the assumption that poorer people are more likely to become infected with HIV, Halperin points out that HIV rates "tend to be higher among people with greater income and education levels. African merchants and schoolteachers can afford to have more sexual partners than unemployed day laborers." Furthermore, African nations with the highest levels of infections are among the "most economically developed and relatively best-organized" countries in Africa. In particular, Halperin focuses on Botswana, the "most prosperous" nation in sub-Saharan Africa with "an enviable political stability and social welfare system," where health care is "universally guaranteed" and "dire poverty" is uncommon. Yet Botswana is "deep in the throes of the AIDS epidemic," with heterosexual intercourse responsible for most infections. As poverty does not seem to be the "overwhelming factor plunging life expectancy to new lows in Botswana," Halperin examines the "unfortunate mixture of traditional and new influences" that contribute to the spread of disease. "No single cause explains why HIV has spread so rapidly through Botswana's population while the virus' prevalence remains below 5% in more poverty stricken and politically chaotic countries like Nigeria or Sierra Leone," Halperin writes, but "a sexually unrepressed village culture" in which boys and girls were permitted to experiment sexually, combined with a "sex-positive" culture where people with money socialize at bars and end up having unprotected sex with different partners, are major disease contributors. In addition, Botswana's "explosive economic growth," fueled by its diamond exports, "intense migration and urbanization," has made pre-marital sex commonplace. Halperin also points to the practice of "dry sex," in which women insert herbs or powders into their vaginas to increase friction and male pleasure, and the abandonment of circumcision in Botswana as facilitating the spread of disease. Yet despite all these factors, causes for the spread of HIV, he notes that many Botswanans "are ready to take steps that will help curb the spread of AIDS," with renewed interest in circumcision. Halperin concludes that rather than maintain the "poverty causes AIDS" assumption, "It is time for biomedical and social scientists to work more closely with African government officials, NGOs and ordinary citizens to help find innovative solutions to the crisis that are informed by science yet rooted in people's own cultural heritage" (Halperin, AIDSLink, 12/2000).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.