cholera in Bangladesh confirms the value of this type of approach (Emch et al., 2010).

There is a long tradition of work on this subject in the geographical sciences (Gould, 1993), but the range of contextual influences needs to be expanded. It is becoming clear that more attention needs to be paid to the influence of attitudes toward sex, female empowerment, and economic inequities on the spread of diseases (Kalipeni et al., 2007). Additional work focused on developing and analyzing data on the spatial distributions of HIV/AIDS and relevant social circumstances can improve understanding of the range of influences on the vulnerability of different people in different places (Kalipeni et al., 2007, 2008).

Globalization and migration are also changing sexual practices in Africa (Ampofo, 2001; Spronk, 2005). As a result of globalization, the media, including cinema, television, and the Internet, provide Africans with new sexual imagery, and undermine traditional boundaries of sexuality and sexual expression. Further research is needed on where these changes are having the greatest impacts, and how they are affecting the spread of HIV/AIDS. Work in this vein could also provide a more detailed understanding of the role of migrant labor on the diffusion of HIV/AIDS (Bassett and Mhloyi, 1991; Jochelson et al., 1991; Hunt, 1996).

Governance is another social factor affecting the spread of HIV/AIDS in Africa and elsewhere. Relatively little attention has been paid to the effects of civil wars and political instability on HIV/AIDS. As victims of armed conflict and as refugees (or internally displaced persons), women and children are particularly vulnerable to sexual violence and abuse. Warring factions often use rape as an expression of violence and revenge against their enemies (Kalipeni and Oppong, 1998). In refugee camps, women and girls remain subjects of sexual coercion; separated from their families and living as internally displaced persons or refugees, survival compels many individuals to engage in transactional sex with other refugees or the host population (Spiegel and Nankoe, 2004). The volatile mix of refugees, soldiers, desperate women with children, and the chaos associated with war facilitates HIV/AIDS spread, but how this plays out in different places is not well understood.

The efforts of multilateral organizations, such as UNAIDS, have focused on assisting governments to deal with the challenge of HIV/AIDS rather than evaluating how the apparatus of government—whether democratic, autocratic, or chaotic—affects HIV/AIDS spread. Yet government leadership, particularly good governance, expressed by effective administration of international aid for HIV/AIDS control, and public health programs including antiretroviral access, influence the success or failure of HIV/AIDS control efforts, as do policies that address poverty and social inequalities. Including such matters in a broadened effort to look at contextual influences on the geographical spread of HIV/AIDS can enhance understanding of how and why disease diffusion patterns are different from place to place.

SUMMARY

The geographical sciences have a role to play in advancing understanding of spatial variations in the spread of disease, access to care, and the treatment and prevention of illness. The tools and approaches of the geographical sciences can provide insights into locational factors affecting health, and they can illuminate important contextual influences on the diffusion of diseases. A major initiative to build upon and expand work in the geographical sciences on health matters would benefit efforts to combat disease and promote human well-being.



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