Sexual Cultures and Migration in the Era of AIDS: Anthropological and Demographic Perspectives

By Gilbert Herdt | Go to book overview

7 Urban-Rural Differentials in HIV/STDs and Sexual Behaviour

MICHEL CARAËL


Introduction

Heterosexual transmission has accounted for about three quarters of the estimated 13 million human immunodeficiency virus (HIV) infections in adults worldwide. In the 1990s, this mode of transmission continues to grow in importance ( WHO/ GPA, 1993). The HIV/AIDS pandemic was initially centred in urban locations. Rural HIV and STD prevalences have generally been found to be much lower than urban prevalences, with some noticeable exceptions. In the developing world, except Latin America, the majority of the population is rural. In the absence of any specific data from rural areas in most countries, HIV projections so far have assumed rural rates to be five to ten times lower than urban rates ( Chin, 1991; Andersonet al., 1991; Mertenset al., 1994). However, in the ten years following the recognition of the HIV epidemic, additional empirical data on the levels and dynamics of HIV transmission and sexual risk behaviours are beginning to nuance the picture. There is now a general perception that several types of HIV epidemics are probably co-occuring at different rates across different groups, in different areas of the same country, making assessment of the current dynamics problematical ( Piotet al., 1990).

In the field of HIV/STD sexual prevention research, rural-urban variations are increasingly under scrutiny, although key issues in measurement are still debated. Indeed, much variation exists between countries in terms of residence classification. Some countries use population-size criteria, such as definitional locales of fewer than 1,500 inhabitants classified as rural, while others use socioeconomic characteristics denoted by the presence of electricity and water supply. Furthermore, many studies about HIV seroprevalence and sexual behaviour implicitly assume that current residence reflects the place of exposure which does not control for the recency of migration and the frequency of travel. Thus, the findings

____________________
The author thanks J. Cleland, T. Mertens, P. Sato, and T. Burton for reviewing the manuscript. He also thanks principal investigators in the selected countries/sites: Dr P. Somse ( Central African Republic); Professor D. Séry and G. Tapé (Côte d'Ivoire); Dr M. Marcos ( Guinea Bissau); Dr G. Awissi ( Togo); Professor N. Ndimurukundo ( Burundi); Dr P. Onyango and Dr P. Waliji-Moloo ( Kenya); Dr A. Lawson ( Lesotho); Dr E. Muhondwa ( Tanzania); Professor A. Haworth and Dr K. Kalumba ( Lusaka); Dr T. Tiglao ( Manila); Professor Kok Lee Peng ( Singapore); Dr A. J. Weeramunda ( Sri Lanka); Dr W. Sittitrai ( Thailand); Dr R. G. Parker ( Rio de Janeiro).

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