Sugar Daddies—than the most sophisticated ''peer education" campaign. It would also reduce unwanted pregnancy, raise the age of marriage and decrease infant mortality, not to mention promoting gender equality. One benefit of women-centered AIDS strategies is that they have positive backward links to many other development objectives.

Thus effective interventions must target not only individual perceptions and behavior, but also the larger context within which those perceptions and behaviors are shaped. In Africa, that context includes laws and policies, social and family structure, sexual debut and the construction of sexual careers, medical and program factors, and economic factors. Structural and individual factors combined produce behavior change. This chapter focuses on those contextual issues we feel may be most directly addressed through intervention.

A wide variety of social, political, and economic factors affect the societal context within which the AIDS epidemic must be viewed; similarly, these factors provide the context for the rest of this report. Among the more salient features of the societal context that affect the size and shape of the HIV/AIDS epidemic in sub-Saharan Africa are the age and gender composition of the population; the construction of sex roles and expectations within society; inequities in gender roles and power; sexual access to young girls and the acceptance of widespread differentials in the ages of sexual partners; rapid urbanization under conditions of high unemployment; considerable transactional sex fostered by limited earning opportunities for women; and lack of access to health care, particularly treatment for STDs. These factors are often exacerbated by social upheavals related to economic distress, political conflicts, and wars. Of course, sub-Saharan Africa is quite heterogeneous with regard to some, if not all, of these factors, so that there is enormous variation in the situation from country to country; particularly noteworthy are the differences between West Africa and East and Southern Africa.


Sub-Saharan Africa is home to around one-tenth of the world's population. Its approximately 1,700 identified ethnic groups constitute over 30 percent of the world's cultures. Each group may have its own form of social organization and its own norms governing reproductive life, family formation, inheritance, and so on. Childbirth and marriage may be synonymous in some groups, or one may be expected to precede the other (in either order). Marriage may be a salient event, an extended process, or simply a convenient social label. Expectations and rules for marriage vary enormously. It may be permanent or fleeting; it may occur once in a lifetime, repeatedly over several years, or concurrently with other marriages. It may carry with it the expectation of fidelity or imply a duty of multiple partnership. Several types of unions may coexist. Some ethnographic accounts describe as many as 14 differently named transactions under the umbrella of marriage in a single society, although colonial administrations apparently

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