Why have socioeconomic explanations been favoured over cultural ones in explaining the extensive spread of HIV in South Africa?

Abstract

The HIV prevalence in South Africa’s various racial/ethnic groups differs by more than an order of magnitude. These differences are determined not by the lifetime number of sexual partners, but by how these partnerships are more likely to be arranged concurrently in African communities. The available evidence demonstrates that neither HIV nor concurrency rates are determined by socio-economic factors. Rather, high concurrency rates are maintained by a culturally sanctioned tolerance of concurrency. Why then do socio-economic explanations trump cultural ones in the South African HIV aetiological literature? In this article, we explore how three factors (a belief in monogamy as a universal norm, HIV’s emergence in a time of the construction of non-racialism, and a simplified understanding of HIV epidemiology) have intersected to produce this bias and therefore continue to hinder the country’s HIV prevention efforts.

Keywords

• HIV, South Africa, epidemiology, sexuality, concurrency, prevention