Topic: What are the structural and behavioral factors affecting the HIV/AIDS pandemic.

As noted by the joint United Nations programme on HIV and AIDS (UNAIDS) and the World
Health Organization (UNAIDS/WHO, 2005:2), HIV and AIDS has since its discovery in 1981
cumulatively taken over 25 million lives, making it one of the worst pandemics in human
history. Care USA estimates that more than 14 million children have been orphaned by the
pandemic, and the number is expected to more than triple by 2010 (www.careusa.org,
24/11/2005). It is also increasingly becoming an issue of concern that although an estimated 40.3
million adults and children are already living with HIV and AIDS globally (National AIDS
Council 2004), infection rates are soaring despite apparent concerted efforts towards prevention
and awareness in many countries. Consequently, this essay seeks to assess the structural and
behavioral factors affecting the HIV/AIDS pandemic.

HIV/AIDS pandemic is driven by a set of sociocultural, socioeconomic and epidemiological

determinants. These determinants are numerous, complex, have many interactions among them
and also have double causality with the pandemic, Ministry of Health and Child Welfare (2005).
While antiretroviral treatment (ART) is becoming increasingly available in developing world,
there is no vaccine against the disease and the majority of infected people still do not have access
to ART, National AIDS Council (2004). Structural factors, defined as the economic, social,
policy, and organizational environments that "structure" the context in which risk production
occurs, are increasingly recognised as important determinants in the acquisition, transmission,
and prevalence of HIV disease. In recent years, extensive research has examined the structural
factors that produce and re-produce HIV risk among high prevalence populations like sex
workers There is thus a need to assess the importance of the HIV/AIDS epidemic determinants’
in order to design an effective policy response, Craven and Stewart (2012).

Care USA (2005) notes that currently more than 95% of people infected with HIV and AIDS live
in the developing world, where there is already existence of scarce financial and material
resources to battle the pandemic through awareness, prevention, care and support as well as
treatment. While it is commendable that HIV prevalence rates are showing signs of declining in
Zimbabwe, the apparent challenge is obviously to maintain such a decline. However the current
realities present a complex situation in which due to the unfavorable macro-economic situation,
human and income poverty which are strongly interlinked with increased risk of HIV spread are
on the rise (Tibaijuka,2005; CCZ, 2005).

Informal settlements are critical examples of such areas as they are endowed with high levels of
concentric poverty and relative isolation in terms of socio-economic amenities. It then goes
without saying that these informal settlements are pockets of high risk to HIV infection and
spread and therefore should be policy priorities among other high-risk areas in terms of response
to the pandemic. Particularly so in the Zimbabwean case, where slum settlements are in peri-
urban areas of commercial farming and mining activities (areas of which were noted to have the
highest HIV prevalence rates ZHDR, 2003:52), there is certainly a need to contain HIV infection
as well as spread in such settlements.

As studies have shown and has been extensively documented (e.g. UNHDR, 2003; Jackson,
2002; ZHDR, 2003), the pandemic in Sub-Saharan Africa has found fertile ground for spread in
poverty that perennially haunts the region. The majority of the countries in the region lie in the
low Human Poverty Index range (UNHDR, 2005) and are characterized by high levels of human
and income poverty, high probability at birth of not living beyond 40, high illiteracy rates and
high unemployment. These factors have without doubt combined to increase risk and
vulnerability to HIV and AIDS among the poor (ZHDR, 2003). The same source also notes that
the plight of women has been worsened by their socio-economic disempowerment rooted in
traditional gender stereotypes. Due to the gender stereotypes, women have been relatively
marginalized in terms of higher learning opportunities and consequently economic self-
sustainability opportunities. Inevitably women have become more prone to poverty compared to
their male counterparts, a scenario known as the feminization of poverty, thereby making the
former more susceptible to sexual abuse and violence as they would be depending on their male
counterparts for survival.

The National Academy of Sciences (2003) established in community-based studies that the harsh
physical and social conditions of urban life have led to chronic stress and depression among
adults. The psychological implications, amid high poverty levels and conditions falling below
humane standards was also confirmed by Warah (2003) and Haque (2003), the latter who
concluded the levels of desperation, fatalism and hopelessness in such situations often lead to
risky health and sexual behaviour including alcohol and drug abuse as well as multiple-partner
sexual relationships. It is with this recognition that Cohen (1998) noted that unless the poverty
situation in Sub-Saharan Africa was addressed, it would be difficult to combat HIV and AIDS. It
therefore means that if sustainable long-term mitigation efforts against HIV and AIDS are ever to
be ensured in Sub-Saharan Africa, it is imperative for poverty alleviation to be seriously
considered as a pivotal component of the overall strategy.

The main areas of concern with regards to cultural practices in the region have been polygyny,
widow inheritance, spouse sharing, female genital mutilation as well as certain initiation rites
(e.g. as in some cultures in Malawi) in which young women are made to sleep with older men as
a form of initiation into womanhood. These are the main causatives that scholars have attributed
to the high prevalence rates and worst impacts of HIV and AIDS in the Sub-Saharan Africa
region.

Multiple and concurrent partnerships have been identified as an important contributor to the high
levels of HIV across the southern African region (SDAC 2006). At the individual level, each
additional partner over one’s lifetime increases the odds of acquiring HIV (Macro International
2008). In addition to raising personal risk of acquiring HIV, multiple partnerships increase the
odds of passing the virus to several other persons. At the population level, each infected
individual needs only infect one new person for the epidemic to be sustained. However, if each
HIV-positive individual infects more than one person on average, the epidemic will grow
(Barnett & Whiteside 2006).

Transactional sex is becoming an increasingly acceptable form of partnership in Zimbabwe

(Mufune 2003). In these types of relationships, sex is exchanged for food, money, gifts, drinks,
transportation, or other favors. These relationships may be long- or short-term, casual or stable.
Transactional sex is born out of a system of widespread poverty and high income inequality, in
which young men and women have few employment options and their access to resources is
almost exclusively through wealthier men (LeBeau & Mufune 2001). However, transactional sex
is not necessarily linked to absolute poverty. It is often used to improve material well-being and
acquire goods and services beyond the individual’s means (Mufune 2003). In these relationships,
high-risk sexual behaviors may become a negotiated part of the transaction, and women may
receive more money or goods for engaging in them (LeBeau et al 2001). Transactional sex,
combined with gender and age differences, may also limit the decision making power of women
in the relationship (LeBeau & Mufune 2001).

An important driver of the HIV epidemic in the Southern African region has been population
movement. Migration substantially increases the vulnerability of individuals to HIV infection,
and also shapes the geographic distribution of the epidemic and the rate at which infection
spreads. Thus, migration is both an individual risk factor as well as a structural factor driving the
epidemic. Research undertaken in Zimbabwe, South Africa and elsewhere confirms that migrants
have higher levels of HIV infections than individuals who have a stable residence over several
years (Lopman 2008; Lurie 2003; Williams, et al. 2002). Migrants have an increased risk of HIV
infection because they tend to have a greater number of sexual partners than non-migrants.

The factors driving the HIV epidemic in Zimbabwe and Southern Africa are numerous and
complex. Currently available data indicate that important behavioral drivers include multiple and
concurrent partnerships combined with inconsistent condom use, inter-generational sex and
transactional sex and low levels of male circumcision. These factors occur within a complex
social and economic context. The behaviors and choices individuals make regarding sex are
shaped by these contextual factors and in Zimbabwe especially by, poverty, unequal access to
resources by women, mobility and cultural norms regarding partnerships. Low risk perceptions
and widespread alcohol abuse aggravate the problem, and reduce motivation to implement safer
sexual practices.
 References

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