HIV-AIDS Perspectives

AIDS-HIV has an unprecedented number of cases, and increased incidence and prevalence of preexisting infectious disease. HIV-AIDS is an emergent infectious disease because it has increased within the past two decades and threatens to increase in the near future. It is also considered an epidemic because incidences are large and widespread beyond what would be considered normal for any given region.

Multi-step pathways have been identified that lead from globalization to increased vulnerability to HIV infection and its consequences among women and children in sub-Saharan Africa by way of five manifestations of, or responses to, globalization at the national level: currency devaluations, privatization, financial and trade liberalization, implementation of user charges for health services and implementation of user charges for education. The first two pathways operate by way of reducing women’s access to basic needs, either because of rising prices or reduced opportunities for waged employment. The third operates by way of increasing migration to urban areas, which simultaneously may reduce women’s access to basic needs and increase their exposure to risky consensual sex. The fourth pathway (health user fees) reduces both women’s and youth’s access to HIV-related services, and the fifth (education user fees) increases risk of exposure to risky consensual sex, commercial sex and sexual abuse by reducing access to education. This explanatory approach complements recent synthetic reviews of research on determinants of vulnerability not only to HIV/AIDS but also to tuberculosis and malaria which concluded that vulnerability to all three diseases is closely linked; that poverty, gender inequality, development policy and health sector ‘reforms’ that involve user fees and reduced access to care are important determinants of vulnerability; and that complicated interactions between these factors, many of which lie outside the health sector, make unraveling of their individual roles and therefore appropriate targeting of interventions difficult

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