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HIV Ed: A Global Perspective  

Ralph J. DiClemente and Nihari Patel

At the end of 2016, there were approximately 36.7 million people living with HIV worldwide with 1.6 million people being newly infected. In the same year, 1 million people died from HIV-related causes globally. The vast prevalence of HIV calls for an urgent need to develop and implement prevention programs aimed at reducing risk behaviors. Bronfenbrenner’s socio-ecological model provides an organizing framework to discuss HIV prevention interventions implemented at the individual, relational, community, and societal level. Historically, many interventions in the field of public health have targeted the individual level. Individual-level interventions promote behavior change by enhancing HIV knowledge, attitudes, and beliefs and by motivating the adoption of preventative behaviors. Relational-level interventions focus on behavior change by using peers, partners, or family members to encourage HIV-preventative practices. At the community-level, prevention interventions aim to reduce HIV vulnerability by changing HIV-risk behaviors within schools, workplaces, or neighborhoods. Lastly, societal interventions attempt to change policies and laws to enable HIV-preventative practices. While previous interventions implemented in each of these domains have proven to be effective, a multipronged approach to HIV prevention is needed such that it tackles the complex interplay between the individual and their social and physical environment. Ideally, a multipronged intervention strategy would consist of interventions at different levels that complement each other to synergistically reinforce risk reduction while simultaneously creating an environment that promotes behavior change. Multilevel interventions provide a promising avenue for researchers and program developers to consider all levels of influences on an individual’s behavior and design a comprehensive HIV risk-reduction program.

Article

HIV/AIDS in South Africa  

Rebecca Hodes

Approximately 36.7 million people worldwide are living with the Human Immunodeficiency Virus (HIV). Almost 20 percent of South Africa’s adult population (aged fifteen to forty-nine) is HIV-positive, and about one in every five people living with HIV worldwide is in South Africa. The pandemic, and the political controversies it elicited, have come to define both local and global understandings of the post-apartheid nation. The history of HIV in South Africa begins in the 1980s during an era of heightened repression by the apartheid state, in which discriminatory laws and fearful public responses tapped into broader prejudices relating to race and sexuality. During the 1990s, as South Africa transitioned to democracy and as rates of HIV reached pandemic levels, partnerships were built between civil society and state actors to confront the many challenges that the HIV epidemic presented. However, from the late 1990s, corruption and the abuse of political power within the Department of Health, together with the government’s refusal to provide life-saving antiretroviral treatment (ART), ignited a new era in health advocacy. While the HIV-treatment activist movement won the struggle for public access to treatment, Jacob Zuma’s succession to President Thabo Mbeki heralded a new era of political controversies in the state’s HIV response. A copious historiography on the HIV epidemic in South Africa maps the contemporary chronology and evolution of the disease, including a focus on changing public understandings and responses

Article

What Drives HIV in Africa? Addressing Economic Gender Inequalities to Close the HIV Gender Gap  

Aurélia Lépine, Henry Cust, and Carole Treibich

Ending HIV as a public health threat by 2030 presents challenges significantly different to those of the past 40 years. Initially perceived as a disease affecting gay men, today, HIV disproportionately affects adolescents and young women in Africa. Current strategies to prevent HIV mostly rely on using biomedical interventions to reduce the risk of infection during risky sex and to address that biologically; women are more vulnerable to HIV infection than men. Ongoing policies and strategies to end the AIDS epidemic in Africa are likely to fail if implemented alone, given they fail to address why vulnerable young women engage in risky sexual behaviors. Evidence strongly suggests economic vulnerability, rather than income level, is a primary driver of women's decision to engage in commercial and transactional sex. By viewing HIV through the lens of structural gender inequality, poverty, and use of risky sexual behaviors to cope with economic shocks, a new explanation for the HIV gender gap emerges. New and promising approaches to reduce HIV acquisition and transmission by protecting women from economic shocks and increasing their ability to participate in the economy have proven effective. Such interventions are vital to break the pattern of unequal HIV transmission against women and if HIV is to be beaten.

Article

HIV and AIDS in Africa  

Krista Johnson

Africa has the largest number of people living with HIV, with an estimated 25.7 million HIV-positive people in Africa by the end of 2018. This figure represents over two-thirds of infected people globally. African women and girls represent a majority of those infected, and Africa is home to three-fourths of all HIV-infected women and girls. Across African countries, there are differences in the sizes and trajectories of HIV epidemics. Southern Africa has the worst epidemic, with the numbers infected still rising in some countries. Prompting a development and governance crisis in many southern African countries, HIV prevalence rates are as high as 20 percent of the adult population in some countries and nearing 50 percent of the adult population in certain communities. East Africa too has been hit hard by HIV, leading to high mortality and morbidity rates in that region as well. In most of West and North Africa, there has been limited spread of HIV, with most countries in these regions having HIV prevalence rates of less than 3 percent. Africa’s encounter with HIV and AIDS began before it was first identified as a medical condition early in the 1980s. However, it was not recognized as an epidemic in most parts of Africa until much later. Framed largely as a public health crisis rather than a developmental one, much of the world’s focus on the AIDS pandemic in Africa has centered on access to treatment, and developing effective prevention strategies that have principally focused on behavior change practices for targeted populations. However, the HIV and AIDS pandemic in Africa did not emerge in a vacuum. It is the consequence of longer historical processes such as massive demographic growth, urbanization, and social change, as well as global inequalities and historical legacies of colonialism and imperialism. In this regard, a historical account of HIV in Africa offers an important corrective to the dominant biomedical response to AIDS in Africa. It is important to take note of longer historical processes that have shaped both the virus and the human response to it.