Sex, poverty and HIV

UNAIDS has been subject to a series of attacks for supposedly kow-towing to political correctness by overplaying the risks of generalised HIV epidemics and failing to concentrate on the risky behaviours of key groups (notably men who have sex with men, sex workers, and injecting drug users) for fear of stigmatising them and causing offense. It has also been taken to task for highlighting gender inequality and poverty as social drivers of the HIV epidemic in Africa rather than facing the challenge of addressing the multiple concurrent sexual partnerships which really fuel it. UNAIDS officials responded by defending the institution's record on prevention and by emphasising that the challenge is to know the local epidemic and its drivers, and to craft interventions accordingly. This, of course, leaves open the question of the relationship between, and relative importance of, the social drivers of HIV (notably poverty) and sexual behaviour. This is especially contentious with regard to Africa. Some stress the importance of sexual culture, whereas others point to the legacy of colonial exploitation and structural adjustment in underpinning behavioural vulnerability to HIV, and even to a hypothesised biological vulnerability of poor people to HIV infection. This paper reviews the evidence on poverty, sexual behaviour and AIDS. It argues that contextual factors within Africa are more salient than economic factors and that a more nuanced and localised approach is indeed an appropriate way forward.