Index
A
Abstinence, sexual, 59, 62, 117, 119, 120, 135, 151, 188
Acquired immune deficiency syndrome. See AIDS
Adolescents.
See also Girls
AIDS stigmatization, 140
definition of, 182
interventions, 169-173, 198-203
peer information and pressures, 183
premarital pregnancy, 116
sexual behavior, 187
Africa Region Private Enterprise Development project, 238, 239
African Medical Research Foundation, 325
Age
asymmetric matching of sexual partners, 61, 62, 77, 113, 116
and risk of HIV infection, 5, 126
and seroprevalence, 75, 76, 77, 79-80, 81
and sexual behavior, 126
Agriculture, impact of AIDS/HIV, 213, 233-234
AIDS
care for people with, 15, 185-186, 209-211, 318
database, 18
and discrimination, 187-188, 209
morbidity and mortality, 14, 69, 76, 216-218
origin, 70
AIDS awareness
asymptomatic transmission, 138
attitudes toward sufferers, 52, 140-141, 187-188
and behavior change, 9, 126, 137, 156, 228
modes of transmission, 136-137
perceptions of risk, 126, 138-140, 151, 212
and testing, 141
AIDS control programs, 49, 264
AIDS International Training Research Program, 260
Alcohol use, and risk of HIV infection, 94, 131
Awareness. See AIDS awareness
B
Bacterial vaginosis, 90, 101, 196
Behavior change
AIDS awareness and, 9, 126, 137, 156, 228
assessment of, 148-151
information/education campaigns and, 9, 156, 324-325
requirements, 158-159
vaccination and, 94
Botswana
HIV/AIDS epidemiology, 46-47, 48, 73, 75
prevention efforts, 177-178, 179-180
Blood transfusions, 82, 83, 97-98
Breastfeeding, 94-96, 135, 191
Burkina Faso
HIV/AIDS epidemiology, 48, 78-79, 82-83
prevention efforts, 171
STDs, 90-91
Burundi
HIV/AIDS epidemiology, 83, 121
impact of AIDS, 206, 207, 208-209, 233
prevention of AIDS, 142-144
sexual behavior, 114, 117, 121, 122-123, 126
C
Cameroon
AIDSCAP project, 330-332
HIV/AIDS epidemiology, 328
panel visit to, 328-332, 338-339
prevention efforts, 171, 245, 328-332
sexual behavior, 63, 114, 129, 134, 135, 150
social and behavioral research, 332
Cameroon Psychology Forum, 332
Cape Verde, 78
CARE, 329
Casual sex, 110, 119-122, 127-128, 129, 151, 228-229
Central African Republic
AIDS awareness, 137
HIV/AIDS epidemiology, 73
sexual behavior, 114, 116, 117, 126, 143-144, 149
STDs, 89
Cervical inflammation, 87
Childbearing.
See also Pregnancy and pregnant women
premarital, 62
social contexts for, 61, 120, 183
Children
blood transfusions, 97
coercive sex with, 132
definition of, 182
educational impact of AIDS, 235
mitigation strategies for, 320-321
mortality rates, 96-97, 216, 218, 219, 220, 223
neonatal effects of STDs, 90
orphans, 14, 50, 97, 183, 186, 205, 214, 216, 223, 318, 320-321, 322
Vitamin A therapy, 192-193
Chlamydia, 12, 67, 84, 85, 87, 89, 90, 100, 195
Circumcision, female, 130
Circumcision, male, 69, 92, 130-131
Civil unrest and wars, 66, 79, 132
Coercive sex, 8, 65, 132, 152, 154
Commercial sex, incidence of, 122-123
Commercial sex industry/workers
economic factors in, 68, 124-125, 131
HIV seroprevalence, 65, 71-72, 74, 75, 79-81, 168, 180, 187
interventions targeting, 63, 165, 166, 173, 178-179, 198-201, 331
and risk of infection, 93, 125-126, 136, 139
sexual contacts, 62-63
sexual practices, 134
STDs, 83, 85, 86-87, 129, 145, 179
surveys of, 112
Community-based interventions. See Interventions
Condoms
AIDS awareness and, 136
attitudes toward, 6, 8, 63, 64, 120, 141-142, 145-148, 167, 180
breastfeeding and, 135
promotion of, 45, 155, 164, 165, 166, 167, 169, 170, 185, 324, 331-332
research recommendations, 8, 154
and sexual behavior, 141-148
and STD/HIV prevention, 92, 145, 178
use, 2, 63-64, 99, 112, 126, 136, 139, 142-145, 150, 152, 166, 167-168, 175, 178, 180, 190, 223
Contraceptives, 13, 63, 91, 135, 167, 196, 223.
See also Condoms
Côte d'Ivoire
HIV/AIDS epidemiology, 47, 48, 71, 73, 75, 78-79, 81, 82-83, 121
impact of AIDS, 206, 216-217, 233
sexual behavior, 114, 116, 117, 121, 122, 127, 149
sex ratios, 65
D
Demographic and Health Surveys (DHS), 101, 110
Demography
of HIV infection, 76-77
societal impacts of AIDS, 216-225
Drug abuse (injected), 98
E
Economic factors
agricultural sector, 213, 233-234
business sector, 235-240
childbearing, 120
education sector, 234-235
family hardships, 211-214
family planning, 225-228
individual hardship due to HIV, 49-59, 209
and interventions, 156
health sector, 67, 205, 213-214, 231-233
per capita income effects, 50, 225-231
research constraints, 265-266
sectoral impacts of HIV/AIDS, 67-68, 231-235
in sexual behavior, 120, 124-125
structural adjustment programs, 68
Education (schooling).
See also Information/education on HIV/AIDS
access to, 184-185
and AIDS awareness, 137
and condom use, 142
higher-education systems, 257-258, 264-265
impact of AIDS/HIV, 234-235, 257-258
and risk of HIV infection, 127, 228-230
Epidemic
societal contexts of, 3-4
spread of, 14, 47, 48, 64-66, 75, 93, 218;
see also Transmission of HIV
Epidemiology
behavioral data limitations, 98-100
biological factors, 69
demography of HIV infection, 4-5, 20, 76-77, 100, 216-225
geographic patterns, 1-2, 46-47, 65, 69, 79-80
social/behavioral research and, 100-101
statistics on AIDS/HIV, 70-76
Ethical issues, in STD/HIV research, 101-103
Evaluation of AIDS programs, 162-163
Extramarital sex, 106, 119-122
F
Families
impact of AIDS on, 186, 211-216
Family AIDS Education and Prevention Through Imams Project, 186
Family planning, 9, 13, 63, 142, 156, 167, 190, 220-221, 223, 225-228, 229
G
Gabon, 89
The Gambia
HIV/AIDS epidemiology, 78, 79, 81, 82, 83
sexual behavior, 109, 112, 142, 145
Gardnerella vaginalis, 90
Gender equality, 11, 167, 174-175, 194.
See also Women's status
Genital ulcer disease, 66, 81, 85, 86-87, 90, 91, 92, 178
Ghana
HIV/AIDS epidemiology, 48, 82-83
prevention efforts, 166, 172-173, 198-199
sexual behavior, 63, 108, 114, 116, 121, 128, 129, 132, 133, 135
Girls
coercive sex with, 133, 152, 184
HIV incidence, 10
interventions, 184-185
risk of HIV infection, 91, 184
sexual behavior, 133
sugar daddies, 57-58, 112, 122, 184
Gonorrhea, 12, 67, 84, 85, 87, 88, 89, 90, 100, 130, 178, 195
Guinea-Bissau
AIDS awareness, 136, 137, 138, 141
condom use, 143-144, 145, 149-150
HIV/AIDS epidemiology, 78, 79, 81, 82
prevention efforts, 198-199
sexual behavior, 108, 112, 114, 122, 126, 136
H
Health care
AIDS treatment, 15, 209-211, 213-214, 231, 232, 318
economic issues, 204-205, 231-233, 266-267
HIV serological counseling, 66
insurance, 242
rationing, 232
Hemophilus ducreyi, 85
Herpes, 84
High-risk groups. See Risk of HIV infections, core populations
Home-based care. See Health care, AIDS treatment
Homosexuality, 84, 93, 134, 254
Human immunodeficiency virus (HIV).
See also Seroprevalence
Asia, 93
counseling, 13-14, 66, 102-103, 164, 165 n.4, 191, 197, 319, 331
cross-reactive immunity, 82
demographics of, 5, 76-77, 127
high-risk populations, 65, 71-72, 79
HIV-2 versus HIV-1, 52, 75, 77-83
infectiousness, 82, 83-84, 91, 92, 145
isolation from genital ulcers, 86-87
latency period, 80, 212-213, 221, 224-225
and stigmatization, 208-209
types and subtypes, 77-78
I
Impacts of AIDS/HIV.
See also Mitigation of HIV/AIDS impacts
economic, 14, 49-50, 205, 209, 225-240
evaluation of, 15
family and friends of AIDS sufferers, 50, 186, 211-216
individuals infected, 207-211
Information/education on HIV/AIDS
and behavior change, 9, 45, 156
effectiveness, 3, 48, 51, 57, 164, 170, 172, 254
messages, 10, 155, 157, 171, 172, 193, 254
peer programs, 165, 179-180, 319, 330-331
targeting, 104
Institution-based interventions. See Interventions
Interagency Working Group on AIDS, 218
Interventions
adolescents (youth), 182-190, 198-203
behavioral, 2, 62, 160-161, 185
capacity-building for, 161
case studies, 169-173, 178-182, 187-190
characteristics of reported programs, 198-203, 331-332
commercial sex industry, 63, 165, 166, 173, 178-179, 198-203
community-based programs, 13, 88, 163, 165-166, 198-201
contextual, 9, 53, 57-58, 150, 152, 156-157
effectiveness, 9-10, 54, 155-156, 164, 166, 172, 188-189, 221
empowerment of women, 176-178, 184-185, 194
evaluation of, 9, 10, 48, 54, 101-102, 162-163, 173, 188-189, 193-194, 242, 243
gender equality promoted in, 11, 151, 176
guiding principles, 160-161
institution-based programs, 13, 163, 164-165, 198-203
national programs, 18
need for, 2-3
population-based programs, 163, 166, 198-201
sexually active men, 166-173
sexually active women, 173-182
targeting, 76-77, 104, 160, 161, 168, 176, 185
typology of programs, 163-166, 169
K
Kenya
AIDS awareness, 137
HIV/AIDS epidemiology, 2, 47, 72, 73, 86-87, 88, 92, 94, 97, 103
impact of AIDS, 215, 232, 233, 236, 237, 238, 245
response to AIDS, 264
sexual behavior, 62, 108, 113, 114, 117, 125, 127, 134, 135, 143-144
STDs, 85, 86-87, 88, 89, 90-91
L
Lesotho
sexual behavior, 114, 117, 126, 127, 128, 149
Liberia, sexual behavior, 115
Life expectancies, 2, 14, 15, 47, 205, 218, 220, 223, 243
Lower-risk groups. See Risk of HIV infection, core populations
M
Malawi
HIV/AIDS epidemiology, 46-47, 65, 73, 96
impact of AIDS, 220, 229, 232, 233
prevention efforts, 192, 198-199
Mali
HIV/AIDS epidemiology, 47, 82-83
sexual behavior, 115
Marital status
and commercial sex, 124-125
and risk of HIV infection, 73, 81, 82-83, 127, 139
Marriage
age differences in, 62
changes in social contexts, 61, 128
Levirate, 135-136
and sexual behavior, 58-59, 61-62, 108, 110, 112-113, 116-119, 121-122, 151, 181
Medical and program factors, 66-67
Menses, sex during, 92, 134, 135
Migration/migrants
and behavioral change, 62
civil unrest and, 66
interventions targeting, 12, 195, 202-203
and risk of HIV infection, 128-129
and sexual behavior, 117, 128-129, 134
rural-urban, 64-65, 66, 68, 76
Military, interventions targeting, 164, 200-201
Mitigation of HIV/AIDS impacts
cost-effectiveness of, 206, 242-243
counseling initiatives, 247-249, 319, 331-332
evaluation of interventions, 242, 243
health care, 210-211
providers, 16, 241-242, 244, 245-246
resource allocation to, 205-206
targeting of assistance, 15-16, 241, 243-244
types of help, 186, 326-327, 242-243, 247
research recommendations, 14-16, 54-55, 243-244
Models/moderling, transmission of HIV and STDs, 91-94, 100, 171, 218
Monitoring HIV/AIDS
behavioral/demographic variables in, 104
HIV incidence studies, 104
surveillance systems, 5, 103-104
Mortality
AIDS, 14, 47, 204, 216-218, 223-225
infant/child, 96-97, 204, 216, 218, 219, 220
STD, 89
Mycobacteria hominis, 90
N
Namibia, 48
Nigeria
AIDS awareness, 136
prevention efforts, 166, 198-199
sexual behavior, 62-63, 108, 109, 113, 115, 116, 120, 122, 123, 128 , 130, 132, 133, 134, 136
STDs, 130
Nongovernmental organizations.
See also individual organizations
intervention activities, 325-326
mitigation activities of, 245-250
social and behavioral research, 332
O
Orphans. See Children
P
Parenteral transmission of HIV, 82, 83, 97-98
Pelvic inflammatory disease, 88, 89
Perinatal transmission of HIV, 13-14, 71, 78, 83, 90, 94-97, 103, 190-193, 197, 205, 216, 218
Polygyny, 59-60, 62, 113, 116, 117, 122, 128, 167, 168
Population growth, 14, 221-223, 225-228, 229, 230
Population Services International, 168, 324
Population-based interventions. See Interventions
Pregnancy and pregnant women
adolescent premarital, 116
cesarean section, 191
and HIV counseling programs, 13-14, 191, 197
HIV infection, 72-75, 81, 91, 174
immunosuppression of, 91
vaginal lavage, 191-192
Premarital sex, 62, 63, 107, 112-116
Prevention of HIV/AIDS.
See also Blood screening;
Condoms;
Information/education on HIV/AIDS;
Interventions;
Sexual transmission of HIV
cost-effectiveness, 2, 13, 47, 196
donor fatigue, 3
economic conditions and, 156
perinatal transmission, 14, 190-193
sexual transmission, 160-190
traditional healer component, 320
women's status and, 10
Private sector
impact of AIDS/HIV on, 235-240
prevention efforts, 171
Prostitutes and prostitution. See Commercial sex industry/workers
R
Rape. See Coercive sex
Recommendations. See Research recommendations
Research in Africa.
See also Social and behavioral research
assessment of needs, 262-263
capacity-building, 16-19, 55, 251-270
community-based, 101-102
constraints on, 253-267
coordination, 18, 16, 19, 260-263, 270
donor policies and practices, 16-17, 18, 19, 258-260, 263, 270
economic conditions and, 265, 266-267
education systems and, 264-265
ethical issues in, 101-103
funding, 17, 19, 253-257, 262-263, 268
gender-specific, 175
international linkages, 17-18, 268
local resource use, 18-19, 269-270
manpower, 18, 255, 257-258, 268-269
political climate and, 19, 263-264, 270
prioritizing, 269
recommendations, 17-19, 267-270
social and behavioral, 19-20, 263-267, 321-322
validation of, 7
Research recommendations
cost-effectiveness studies, 13, 196
evaluation of interventions, 10-11, 193-194
HIV incidence studies, 5, 12, 104
impacts of HIV/AIDS, 15
interventions targeting migrants and disenfranchised, 12, 195
interventions targeting women and adolescents, 10, 193
female-controlled barrier contraceptives, 13, 196
gender equality interventions, 194
mitigation of HIV/AIDS impact, 15-16, 243-244
multidisciplinary approach, 5-6
pregnancy-related HIV counseling programs, 13-14, 197
research capacity-building in Africa, 17-19, 267-270
sexual behavior information collection, 7-8, 153-154
sexual networks, 152-153
surveillance systems for monitoring STDs/HIV, 5, 103-104
vaginal microbiocide, 11, 194-195
Risk of HIV infection
age and, 126
core populations, 65, 71-72, 93
economic conditions and, 68
education and, 127
models/modeling, 91-94
structural adjustment programs and, 68
Roads, major, as corridors for HIV, 65-66, 75
Rwanda
HIV/AIDS epidemiology, 50, 71, 83, 92, 94, 138, 223
mitigation initiatives, 210
prevention efforts, 164, 165, 198-201
sexual behavior, 108, 115, 121-122, 125
S
Sahel region, 135
Scarification, cosmetic, 98
Senegal
HIV/AIDS epidemiology, 78, 80, 81, 82
sexual behavior, 112
Seroprevalence
blood donors, 97
commercial sex workers, 65, 71-72, 74, 75, 79-81, 168, 187
heterogeneity in, 4-5, 71, 75-76
and mortality rates, 223-225
pregnant women, 72-75, 81, 174
surveillance systems, 71, 103-104
urban-rural differentials, 71, 73, 79, 223
Sex education, 190
Sexual behavior in sub-Saharan Africa.
See also individual behaviors
AIDS awareness and, 136-141
assumptions about, 59
beliefs and practices, 7-8, 99, 131-136, 151-152, 153, 183
change in, 148-151
coital frequency, 92, 111, 112, 118
condoms and, 141-148
data collection methods, 7, 106-112
implications of, 151-152
initiation of sexual activity, 7, 111, 112-116, 128, 153
number of partners, 125-126
patterns of sexual activity, 62, 112-125, 153-154
perceived risk and, 126
reporting, 152
research needs, 7-8, 54, 153-154
risk factors in, 125-131
urban-rural differences, 127-128, 221
vaccination and, 154
women's status and, 174-175
Sexual networks.
See also Marriage;
Polygyny
abstinence and, 135
and HIV transmission, 6, 61-62, 93
mapping, 150
research needs, 98-99, 152-153
Sexual transmission of HIV
prevention strategies, 160-190
risk factors in, 4, 76-77, 83-84, 125-131, 158-159
sexual networks and, 61-62
STDs and, 2, 4, 12, 54, 69, 81, 82, 83, 84-94, 129-130, 132, 195
Sexually transmitted diseases (STDs).
See also individual diseases and organisms
attitudes and beliefs about, 8, 67, 130, 133, 154
control measures, 67, 142, 325
deliberate transmission of, 150
diagnosis and treatment, 12, 45, 66, 67, 87, 100-101, 129, 130, 145 , 164, 165, 169, 171, 172, 175, 181, 195-196
ethical issues in research, 103
health consequences, 51, 88-91, 130
and HIV transmission, 1, 2, 4, 54, 72, 79, 81, 82, 83, 84-94, 129-130, 132, 195
models of transmission, 91-94
monitoring, 103-104
prevalence and incidence in Africa, 64, 84-86, 179
reporting of, 67
research recommendations, 12
rural-urban migration and, 64, 65
socioeconomic implications, 90
synergy of HIV and, 85-88, 195
Sierra Leone, 214-215
Simian immunodeficiency virus (SIV), 78
Social and behavioral research
education system and, 264-265
environment for, 263-267
epidemiological research combined with, 100-101, 104
initiatives in Africa, 321-322, 327-328, 332
limitations of existing data, 98-100
need for, 19-20, 50-51, 98-100
South Africa
HIV prevalence, 65
impact of AIDS, 213-214
mitigation of AIDS, 210-211
sexual behavior, 65, 109, 116, 133, 134
Stigmatization, 8, 64, 67, 84, 140-141, 208-209
Surveys.
See also individual surveys
age cut-offs, 110-111
behavioral, 7, 106-107, 110, 149
validation of, 110, 111-112, 153
Swaziland, 128
Syphilis, 84, 85, 89, 90, 125, 130
T
Tanzania
AIDS awareness, 137, 138-139, 140, 208
AIDS Control Program, 324-326
HIV/AIDS epidemiology, 47, 48, 65, 71, 73, 83, 88, 92, 103, 168, 183, 323
impact of AIDS, 207, 213, 214, 215, 229, 232, 233, 234, 235
mitigation initiatives, 210, 245
prevention efforts, 88, 142, 164-165, 172-173, 200-201, 323-326
research capacity, 254-257, 261-262, 327-328
sexual behavior, 111, 115, 117, 122-123, 126, 127, 128, 129, 142, 143-144
Tattooing, 98
Testing for HIV
and counseling, 102-103
infants, 95
Togo
sexual behavior, 115, 117, 126
Traditional medicine and healers, 98, 130, 165, 320
Transmission of HIV.
See also Parenteral transmission of HIV;
Perinatal transmission of HIV;
Sexual transmission of HIV
asymptomatic, 138
deliberate, 150
primary mode, 4
Traumatic sex, 92.
See also Coercive sex;
Dry sex
Trichomonas vaginalis, 85, 90, 195-196
Trichomoniasis, 12, 84, 85, 87, 101, 178
Truck drivers, 65, 164-165, 200-201, 325
U
Uganda
condom use, 148
HIV/AIDS epidemiology, 2, 45, 46-47, 48, 50, 65-66, 71, 73, 76, 77 , 85, 93, 94, 96, 103, 168, 183, 216, 221 n.4
impact of AIDS, 206, 207, 213, 215, 217, 225, 233, 234
mitigation initiatives, 210, 211
prevention efforts, 165, 166, 186, 190, 200-201, 223
research capacity, 254, 257, 258, 261, 266
sexual behavior, 62, 93, 108, 109, 120, 127, 131, 133, 134, 136, 150
United Nations Children's Fund, 49, 318, 322, 329
United Nations Development Program, 49
United Nations Programme on AIDS, 3, 19, 270
Ureaplasma urealyticum, 90
U.S. Agency for International Development, 318, 324, 325, 328, 329
V
Vaccination, HIV, 2, 8, 45-46, 51, 94, 139, 154, 267
Vaginal microbiocide, 11, 174, 194-195
Vas deferens occlusion, 89
Vitamin A therapy, 192-193, 197
W
West Africa.
See also individual countries
AIDS awareness, 136
HIV/AIDS epidemiology, 75
impact of AIDS, 207
sexual behavior, 116
women, 60-61
Women's status
adolescent girls, 184
economic conditions and, 68
and HIV prevention, 10, 151, 173, 194
labor force participation, 60-61
marital status and, 61
and sexual behavior, 174-175, 184
widow inheritance, 136
World Bank, 49, 68, 207, 235, 318, 323
World Fertility Surveys, 89, 110
World Health Organization
Global Programme on AIDS, 3, 49, 106, 187
seroprevalence estimates, 1
Y
Young males
interventions, 169-173
Z
Zaire
HIV/AIDS epidemiology, 47, 48, 50, 68, 73, 75, 87, 94, 96, 180
prevention efforts, 166, 169-173, 178-179, 200-201, 264
Zambia
AIDS awareness, 137, 138-139, 141
HIV/AIDS epidemiology, 2, 46-47, 48, 83, 94, 168, 223, 316-317
impact of AIDS, 215, 232, 234, 236
mitigation initiatives, 210, 211, 245, 319-321
panel visit to, 316-322, 337-338
prevention efforts, 142, 171, 183-184, 200-201, 317-319
research capacity, 262, 321-322
sexual behavior, 63, 115, 117, 126, 132, 133, 134, 142, 143-144, 151
STDs, 89-90
Zimbabwe
AIDS awareness, 138
HIV/AIDS epidemiology, 2, 47, 48, 88, 96, 184
impact of AIDS, 214, 220, 221, 232, 236, 237, 238, 245
prevention efforts, 164-165, 166, 172-173, 202-203
research capacity, 261
sexual behavior, 62, 109, 112, 115, 123, 132, 133
STDs, 88