Cultural practices contributing to the transmission of human immunodeficiency virus in Africa.

Differences between the epidemiology of AIDS cases in Africa and that in Western societies have prompted speculation regarding risk factors that may be unique to Africa. Because of the age and sex distribution of AIDS cases in Africa, emphasis has been placed on sexual transmission of human immunodeficiency virus (HIV). Factors thought to influence this sexual transmission include (1) promiscuity, with a high prevalence of sexually transmitted disease; (2) sexual practices that have been associated with increased risk of transmission of AIDS virus (homosexuality and anal intercourse); and (3) cultural practices that are possibly connected with increased virus transmission (female "circumcision" and infibulation). Other nonsexual cultural practices that do not fit the age distribution pattern of AIDS but may expose individuals to HIV include (1) practices resulting in exposure to blood (medicinal bloodletting, rituals establishing "blood brotherhood," and possibly ritual and medicinal enemas); (2) practices involving the use of shared instruments (injection of medicines, ritual scarification, group circumcision, genital tatooing, and shaving of body hair); and (3) contact with nonhuman primates. At the current time promiscuity seems to be the most important cultural factor contributing to the transmission of HIV in Africa.