A Cost–Benefit Approach
Chapter 18: Sex and HIV I: The Role of Transmission
Although HIV is largely a hunger issue in SSA, this does not mean that it is unnecessary to discuss the role of sexual activity. As we know, the main type of transmission in SSA is through unprotected heterosexual sexual intercourse. So an examination of sexual behavior in SSA cannot be kept out of the equation. In the next three chapters we will analyze what is known about the role of sexual activity in the heterosexual transmission of HIV. In this chapter we focus on individual behavior and in the next two chapters we extend the analysis to cover sexual behavior in a social context. Because we will be concentrating on heterosexual transmission, we will proceed from a discussion of why HIV prevalence is so high in SSA relative to other regions, to an examination of why HIV is so prevalent among African Americans relative to other races in the United States. To help understand why HIV in SSA is more of a hunger issue than one of extreme sexual behavior, we will cover in detail the study by Oster (2005) and tie this in with the work of Eileen Stillwaggon (2002, 2006) referred to in earlier chapters. WHY SEXUAL BEHAVIOR CANNOT BE THE CHIEF DETERMINANT OF THE HIGH HIV PREVALENCE RATES IN SSA Stillwaggon (2002) makes clear that sexual activity, in an otherwise healthy person, is an inefficient way of transmitting HIV. She cites these facts related to sexual transmission in the United States and Europe: (1) transmission from an...
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