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  • Title: The social impact of AIDS in Sub-Saharan Africa.
    Author: van de Walle E.
    Journal: Milbank Q; 1990; 68 Suppl 1():10-32. PubMed ID: 2381376.
    Abstract:
    The potential expansion of the HIV epidemic and its cultural impact in sub-Saharan Africa are vast. Projections under conservative assumptions suggest that the toll of AIDS will reach five million annual deaths by 2010, although the net African population will continue to increase significantly. Cultural practices, including large differences in age between men and women at marriage and a long period of postpartum abstinence, have contributed to the frequency of extramarital relations and eased the spread of sexually transmitted diseases. In response to the spread of AIDS, social adaptations will include profound changes in sexual behavior, marriage customs, and childbearing. Social values, traditions, and norms related to age and sex distribution, morbidity and mortality patterns, urbanization, marriage, sexual practices, and childbearing have largely shaped the AIDS epidemic in many sub-Saharan African countries. While one may only speculate on the extent of HIV infection and its long-term impact on these societies, one can expect changes to occur in these demographic and cultural patterns. Strongly interrelated factors inherent to some of these societies and affecting the observed pattern of HIV infection include the length and acceptability of postpartum female sexual abstinence, the acceptability of pre- and extramarital sexual relations and prostitution, age differences between men and women at 1st marriage, and the degree of urbanization. Some countries traditionally have long periods of postpartum female sexual abstinence, accepted male extramarital relations over the period, and large age differences between spouses. Where such population characteristics exist, especially in cities, the risk of husband-wife HIV transmission may be significant. Moreover, a high probability of contracting and transmitting the virus may only be exacerbated in societies which expect female virginity at marriage, while nonetheless tolerating prostitution. Evidence to this effect may be observed in the differing social conventions and infection rates of Kigali and Kinshasa. The spread of infection in the future will heighten cultural discrepancies between the behavior of peoples in rural and urban areas, and upset the growing social and economic advantage of the city over rural areas. Societies will, however, adapt and develop new long-term behavioral and cultural norms out of necessity will emerge, accompanied by a nonetheless continued urbanization and total population growth.
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