the many who are left behind creates an environment conducive to exploitation and the rapid spread of the virus. For example, economic problems and structural adjustment may hinder women's access to job opportunities in urban formal-sector labor markets. With no other opportunities, women are forced to resort to commercial sex or to rely on multiple partnerships to support themselves and their children. In Zaire, for example, the economic crisis has led to an increase in the number of young rural women migrating to the towns and cities and to the proliferation of various forms of multiple-partner relationships for economic reasons (Schoepf, 1988).

In a recent review, Lurie et al. (1995) argue that the International Monetary Fund (IMF) and the World Bank's structural adjustment programs may have heightened people's risk of HIV infection by (1) reducing the sustainability of a rural subsistence economy, (2) developing a transportation infrastructure, (3) increasing migration and urbanization, and (4) reducing spending on health and social services. Although not the sole reason for the spread of HIV, such programs "may have only exacerbated pre-existing circumstances or simply failed to reverse adverse trends" (Lurie et al., 1995:539). While one negative consequence of economic development is that it facilitates the spread of communicable disease by bringing people into closer and more frequent contact (Feachem et al., 1995), Lurie et al. (1995) argue that there is a need to develop alternative development models that strive to have a less harmful effect than current policies on the spread of HIV.



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