Geography Reference
In-Depth Information
by the epidemic; HIV prevalence rates among the adult population
ranged from 11 per cent in Malawi to 26 per cent in Swaziland in 2009
(UNAIDS, 2010). The costs and pricing policies of transnational phar-
maceutical corporations, as well as donor discourses and ideologies,
prevented access to life-prolonging antiretroviral treatment in many
African countries until the mid-2000s and led to high numbers of
AIDS-related deaths. Jones (2004) argues that the almost exclusive
focus of donor agencies in the 1980s and 1990s on prevention activities
to halt the spread of the disease, rather than on the treatment and care
of people living with HIV, is linked to multi-layered colonial metaphors
and the racial stereotyping of African people within Western develop-
ment discourses. The epidemic was viewed predominantly through the
lens of sexual practices and interventions focused on the problematic
behaviour of particular 'risk groups', while the political, economic,
social and cultural contexts of HIV transmission were overlooked
(Oppong and Kalipeni, 2004).
As a result, HIV prevention interventions have tended to be based on
Western models of sexual behaviour change that have had little impact
in many African countries. Some argue that such approaches have con-
tributed to increased vulnerability to infection and HIV- and AIDS-related
stigma. The ABC approach (
A
bstinence,
B
e faithful, use
C
ondoms),
which has been used in many African countries, most notably in
Uganda, often promoted moralistic messages about sexual behaviour
and emphasized abstinence and condom use. Such HIV prevention mes-
sages, however, failed to take account of the high value placed on fertil-
ity, religious beliefs and patterns of sexual networking in many African
contexts (Thornton, 2008). They also undermined local cultural under-
standings about well-being, health and illness (Liddell et al., 2005).
In addition, prevention activities have often been targeted exclu-
sively towards women and did not take account of power imbalances in
gender relations and other social and cultural factors that influence
vulnerability to HIV infection (Bujra, 2002). Young women aged 15-24
years are up to three times more likely to be infected than young men
of the same age in Eastern and Southern African countries due to a
combination of biological, economic, social and cultural factors
(UNAIDS, 2010). Young women's low socio-economic status means that
they may seek or be coerced into transactional sexual relationships
with older men who support them financially. They occupy a weak bar-
gaining position to negotiate safer sex, in the context of strong cultural
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