Sexual behaviour, AIDS and poverty in Sub-Saharan Africa.

Within the rapidly progressing pandemic of the acquired immunodeficiency syndrome (AIDS) Sub-Saharan Africa plays a disproportionally large role. The reported data indicate that heterosexual transmission is the predominant cause for the rapid spread in this, one of the world's poorest regions. Prostitution, though poorly understood in the African context, unstable family structure, lack of male circumcision, aversion to, and high cost of, condom use, and risky sexual behaviour, including multiple sexual contacts and partners, are causal and facilitating factors in the rapid spread of HIV infection. Virtually all of these factors are related to poverty. Education and information, which in the absence of an effective curative drug and/or vaccine, would be essential, is also a costly undertaking. Deeper understanding of and increased attention to the economic, as well as social and cultural, parameters of the Sub-Saharan AIDS endemic is needed for the implementation of preventive measures.