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Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×

Preventing and Mitigating AIDS in Sub-Saharan Africa

Research and Data Priorities for the Social and Behavioral Sciences

Barney Cohen and James Trussell, editors

Panel on Data and Research Priorities for Arresting AIDS in Sub-Saharan Africa

Committee on Population

Commission on Behavioral and Social Sciences and Education

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.
1996

Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×

NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, D.C. 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The project that is the subject of this report was funded principally by the Bureau for Africa of the U.S. Agency for International Development (USAID) through a cooperative agreement administered by USAID's Office of Health and Nutrition. The Andrew W. Mellon Foundation also provided funding to the Committee on Population for this project.

Library of Congress Cataloging-in-Publication Data

National Research Council (U.S.). Panel on Data and Research Priorities for Arresting AIDS in Sub-Saharan Africa.

Preventing and mitigating AIDS in Sub-Saharan Africa : research and data priorities for the social and behavioral sciences / Barney Cohen and James Trussell, editors ; Panel on Data and Research Priorities for Arresting AIDS in Sub-Saharan Africa, Committee on Population, Commission on Behavioral and Social Sciences and Education, National Research Council.

p. cm.

Includes bibliographical refererences and index.

ISBN 0-309-05480-X

1. AIDS (Disease)—Africa, Sub-Saharan. I. Cohen, Barney, 1959- . II. Trussell, James. III. Title

RA644.A25N264 1996

614.5′993—dc20 96-11347

CIP

Additional copies are available for sale from
National Academy Press
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Copyright 1996 by the National Academy of Sciences. All rights reserved.

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Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×

PANEL ON DATA AND RESEARCH PRIORITIES FOR ARRESTING AIDS IN SUB-SAHARAN AFRICA

JANE MENKEN (Cochair),

Population Studies Center, University of Pennsylvania

JAMES TRUSSELL (Cochair),

Office of Population Research, Princeton University

KOFI AWUSABO-ASARE,

University of Cape Coast, Cape Coast, Ghana

JOHN G. CLELAND,

Center for Population Studies, London School of Hygiene and Tropical Medicine

CARL KENDALL,

Department of International Health and Development, Tulane School of Public Health and Tropical Medicine

PETER R. LAMPTEY,

Family Health International, Arlington, Virginia

EUSTACE P.Y. MUHONDWA,

The Population Council, Dar es Salaam, Tanzania

A. MEAD OVER,

The World Bank, Washington, D.C.

THOMAS C. QUINN,

Infectious Disease Division, Johns Hopkins University

DEBORAH L. RUGG,

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, Georgia

DANIEL TARANTOLA,

François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health

JUDITH WASSERHEIT,

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, Georgia

MARIA J. WAWER,

Center for Population and Family Health, Columbia University

PETER O. WAY,

International Programs Center, Bureau of the Census, U.S. Department of Commerce

DEBREWORK ZEWDIE,

The World Bank, Washington, D.C.

National Research Council Staff

BARNEY COHEN, Study Director

TRISH DeFRISCO, Senior Project Assistant

Liaison Representatives to the Panel

BENOIT FERRY,

World Health Organization, Global Programme on AIDS

DEAN T. JAMISON,

Board on International Health, Institute of Medicine

Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×

Consultants to the Panel

BETSY ARMSTRONG,

Population Studies Center, University of Pennsylvania

LORNA EDWARDS,

Harare, Zimbabwe

JENNIFER JOHNSON-KUHN,

Department of Anthropology, Northwestern University

SAHR KPUNDEH,

National Research Council

ALEXIS KUATE,

Ministry of Health, Yaoundé, Cameroon

ANNICK MADY,

Association de Soutien à L'Autopromotion Sanitaire et Urbaine, Côte d'Ivoire

DECLARE MUSHI,

Tanzania AIDS Project, Dar es Salaam, Tanzania

RICHARD ODINDO,

Medical Education Department, Nairobi, Kenya

ELIZABETH PISANI,

Center for Population Studies, London School of Hygiene and Tropical Medicine

CHRISTINE SOLOMON,

Family Health International, Arlington, Virginia

LAURA ZANINI,

François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health

Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×

COMMITTEE ON POPULATION

RONALD D. LEE (Chair),

Departments of Demography and Economics, University of California, Berkeley

CAROLINE H. BLEDSOE,

Department of Anthropology, Northwestern University

JOSE-LUIS BOBADILLA,

World Bank, Washington, D.C.

JOHN BONGAARTS,

The Population Council, New York

JOHN B. CASTERLINE,

The Population Council, New York

LINDA G. MARTIN,

RAND, Santa Monica, California

MARK R. MONTGOMERY,

The Population Council, New York

ROBERT A. MOFFITT,

Department of Economics, Brown University

ANNE R. PEBLEY,

RAND, Santa Monica, California

RONALD R. RINDFUSS,

Carolina Population Center, University of North Carolina, Chapel Hill

JAMES P. SMITH,

RAND, Santa Monica, California

BETH J. SOLDO,

Department of Demography, Georgetown University

MARTA TIENDA,

Population Research Center, University of Chicago

AMY O. TSUI,

Carolina Population Center, University of North Carolina, Chapel Hill

JOHN G. HAAGA, Director

BARNEY COHEN, Program Officer

TRISH DeFRISCO, Senior Project Assistant

KAREN A. FOOTE, Program Officer

JOEL A. ROSENQUIST, Project Assistant

JOYCE E. WALZ, Administrative Associate

Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Harold Liebowitz is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Harold Liebowitz are chairman and vice chairman, respectively, of the National Research Council.

Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×

Acknowledgments

This report is the product of the efforts of many people. The panel was established under the auspices of the Committee on Population. The committee, chaired by Ronald Lee, was responsible for establishing the panel and for reviewing the final report.

We are most grateful to the organizations that provided financial support for the work of the panel: The Bureau for Africa of the U.S. Agency for International Development and the Andrew W. Mellon Foundation. Besides providing funding, the representatives of these organizations were a valuable source of information and advice in the development of the panel's overall work plan.

Special thanks are due to Claude Cheta, Hortense Deffo, Jean-Pierre Edjoa, Zakariaou Njoumeni, and others on the staff of the Institut de Recherche et des Etudes de Comportements (IRESCO) in Cameroon, who prepared two very useful background papers for the panel.

Thanks are also due to Lorna Edwards, Alexis Kuate, Annick Mady, Declare Mushi, and Richard Odindo for their help implementing a questionnaire to non-governmental organizations in various sub-Saharan African countries; to Jeff O'Malley and Ioanna Trilivas, who participated in the design of the survey; and to Sahr Kpundeh, who managed its implementation.

We are very grateful to the numerous researchers and policy makers in Africa who made time in their busy work schedules to talk to members of the panel during their mission to Africa in January and February 1995.

We are especially indebted to Betsy Armstrong for her many hours of thoughtful editing, to John Belanger and Joanna Sadowska for checking and rechecking of the references, and to Claire Del Medico and Amy Worlton for

Page viii Cite
Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×

preparation of the manuscripts. We are also grateful to Elizabeth Pisani and Christine Solomon for their substantial contributions to Chapters 4 and 5, respectively. Special thanks are due as well to Trish DeFrisco for her superb administrative and logistical support to the panel, to Jennifer Johnson-Kuhn for her valuable research assistance on Chapter 6, to Rona Briere for her skillful editing of the report, and to André Lux for his excellent translation of the Summary into French.

We owe the greatest debt to Barney Cohen, who managed the entire process and ensured that we met our deadlines and whose intellectual contributions can be found in every chapter of the report, especially Chapters 1, 2, 6, and 7.

We close by expressing our heartfelt appreciation to the members of the panel who contributed long hours and their special expertise to the crafting of this report. Kofi Awusabo-Asare and Daniel Tarantola prepared the initial draft of sections of Chapter 2; Thomas Quinn, Maria Wawer, and Peter Way prepared the initial draft of Chapter 3; John Cleland prepared the initial draft of Chapter 4; Peter Lamptey, Deborah Rugg, and Carl Kendall prepared the initial draft of Chapter 5; and Mead Over prepared the initial draft of Chapter 6.

James Trussell and Jane Menken, Cochairs

Panel on Research and Data Priorities for Arresting AIDS in Sub-Saharan Africa

Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×

4

 

SEXUAL BEHAVIOR AND HIV/AIDS

 

105

   

Sources of Information,

 

106

   

Questions of Methodology,

 

106

   

Patterns of Sexual Activity,

 

112

   

Sex-Related Risk Factors,

 

125

   

Sexual Practices and Beliefs,

 

131

   

AIDS Awareness,

 

136

   

The Role of Condoms,

 

141

   

Behavior Change,

 

148

   

Conclusions,

 

151

   

Recommendations,

 

152

5

 

PRIMARY HIV-PREVENTION STRATEGIES

 

155

   

Behavior-Change Intervention Program Design and Evaluation,

 

157

   

Intervention Evaluation,

 

162

   

A Typology of Intervention Programs,

 

163

   

Interventions Targeting Sexually Active Men,

 

166

   

Interventions Targeting Sexually Active Women,

 

173

   

Interventions Targeting Youth,

 

182

   

Perinatal Transmission,

 

190

   

Recommendations,

 

193

   

Annex 5-1: Selected AIDS Intervention Programs in Africa,

 

198

6

 

MITIGATING THE IMPACT OF THE EPIDEMIC

 

204

   

Introduction,

 

204

   

Impact on Persons with HIV,

 

207

   

Impact on Extended Family Members and Friends,

 

211

   

Indirect Impact of AIDS on the Rest of Society,

 

216

   

Attempts to Mitigate the Impact of HIV/AIDS,

 

240

   

Recommendations,

 

243

   

Annex 6-1: A Brief Survey of Nongovernmental Organizations Implementing Mitigation Programs in Sub-Saharan Africa,

 

245

7

 

BUILDING CAPACITY FOR AIDS-RELATED RESEARCH

 

251

   

Introduction,

 

251

   

Constraints on Research in Sub-Saharan Africa,

 

253

   

Recommendations,

 

267

Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
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Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
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Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
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Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
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Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
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Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
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Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
Page R7
Page viii Cite
Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
Page R8
Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
Page R9
Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
Page R10
Suggested Citation:"FRONT MATTER." National Research Council. 1996. Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. Washington, DC: The National Academies Press. doi: 10.17226/5177.
×
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The AIDS epidemic in Sub-Saharan Africa continues to affect all facets of life throughout the subcontinent. Deaths related to AIDS have driven down the life expectancy rate of residents in Zambia, Kenya, and Uganda with far-reaching implications. This book details the current state of the AIDS epidemic in Africa and what is known about the behaviors that contribute to the transmission of the HIV infection. It lays out what research is needed and what is necessary to design more effective prevention programs.

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