As you may well know, there has been a whole lot of talk going on about how poverty oftentimes is a contributor to the AIDS epidemic. While this claim may sound very plausible, it falls flat on its face when AIDS touches those who not only live in poverty, but are in an area with plenty of resources to prevent the spread of this disease. Dr Edward C. Green, Senior Research Scientist in the School of Public Health, Center for Population and Development Studies, Harvard University has written a short essay on the relation between poverty and AIDS and how it has REALLY impacted the continent of Africa.
Poverty Does Not Mean that Effective AIDS Prevention Is Impossible
One often reads and hears nowadays that poverty underlies AIDS, or at least that poverty drives the epidemic. The same is often said of marginalizion. In a recent article, Richard Parker comments, “In all societies, regardless of their degree of development or prosperity, the HIV/AIDS epidemic continues to rage, but it now affects almost exclusively the most marginalized sectors of society.” That presumably means that those primarily infected with HIV may not always be poor, but they are likely to be marginlized, that is, members of groups on the margins of society, such as IDUs, men who have sex with men, commercial sex workers, or racial minorities. This may be true for the United States and Brazil (where Parker has done much AIDS work), but it this is not an accurate statement for Africa.
Let us consider the first proposition. One explanation for why poverty causes or underlies AIDS is that poor women turn to sex work, putting themselves and their partners at risk, risk that would no exist if such women had not had to resort to sex work. Another argument is heard less often, namely that poverty leads to poor nutrition, which makes may make people shed more viruses and be more infective if they are already HIV-positive (Stillwagon 2002). Or that poor nutrition and weakened immune systems (more related to concurrent infections than to poor nutrition) makes people more susceptible to HIV infection in the first place (Root-Bernstein 1993). Those who accept that poverty underlies AIDS proposition uncritically can be led to proposing AIDS prevention solutions such as “forgive Africa’s debt” and “overthrow the World Bank.”
We see at once that there must be more to the story, at least in Africa, because the wealthiest African countries (South Africa, Botswana, Swaziland, and until very recently, Zimbabwe) in fact have the highest HIV infection rates on the continent (25-40%), not the lowest as we might expect. Meanwhile, some of the poorest countries (Somalia, Guinea, Liberia, Mali, Eritrea) have among the lowest rates (under 3%). Certainly the two African countries that stand out as successful in reversing the direction of HIV infection rates, Uganda an Senegal, cannot be called wealthy. Uganda’s GNP per capita income is about $240, while Senegal is under $240 (Sittitrai 2001).
In fact, there is growing evidence that affluence rather than poverty can drive local HIV epidemics. Several studies in Africa (e.g. Over and Piot, 1993; Smith et al 1999; Vandemoortele and Delamonica 2000) have shown that there is an association between increased education and income, increased HIV risk behaviors, and increased HIV infection. And, not so incidentally, with increased use of condoms. (more…)
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