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Protection can be costly: the poorest simply do not have the option to make the right choice. Under conditions where a glass of clean water is luxury, spending resources on condoms or on breast milk substitutes in order to prevent mother to child transmission is not even an issue. If a decision has to be made whether to walk ten miles to the next trading center to buy a condom or whether to buy a fish from the neighbour to feed the family, the outcome is obvious.
Poor people often do not have the choice to protect themselves. Poverty entails being unable to manage risk. Even where people know exactly how HIV is transmitted and the risks that they are running, many have no real option but to run the risk. The parallel with environmental degradation stands out: poor people across Africa engage in environmentally destructive practices, not from ignorance, but from lack of alternative sources of income.
Poverty forces them into short-term behaviours that undermine their long-term prospects. So it is for many poor youth in Africa, especially young women: their entire lives consist of uncertainty and risk, playing off one set of immediate pressing concerns against another, less visible and less immediate risk. Poverty drives women to unprotected sex. There is research that indicates that the poorer the sex worker, the less likely she is to ask for or insist on using a condom.
Competition among commercial sex workers means that those who demand safe sex may be forced out of the market. The key factor in the latter is poverty. Poverty contributes to migration, which is a major risk factor for HIV. A different association between poverty and the spread of HIV occurs when men have to leave their families for far away places where they have better job opportunities. These migrant workers, being deprived of their wives, have the tendency to engage in casual sex in the locations where they find work.
Not only is the transmission rate amongst people working and living around these workplaces e. Many conscripts chose a military career because of poverty. Far away from home, and under very harsh circumstances, casual sex is tempting. Poverty contributes to work in the informal sector, which can also be a risk factor for HIV. Lack of employment opportunities in the formal sector have contributed to a flourishing informal sector in many African countries.
Informal economies are based on trade, including smuggling and providing services to traders. One of the few African economic sectors that is booming is based on long-distance trading. Informal economy activities tend to be insecure, and to congregate together.
Lastly, poverty is closely associated with factors such as undernutrition, susceptibility to other diseases including STDs and risk of harmful traditional practices such as female circumcision. These are all in themselves risk factors for HIV transmission, especially for women.
Clearly, poverty predisposes to vulnerability to HIV. However, equally important is the structure of poverty, or—to use different language—the inequalities built into impoverishment in Africa. Individual poverty does not always correlate closely with risk. For example, the category of men most at risk from HIV includes many who are relatively well-educated and well-off. They are not the poorest. What renders them at high risk of HIV is their readiness to engage in multiple sexual liaisons.
Their ability to do this arises from the pronounced inequality that is a feature of African societies and economies; they can easily exploit vulnerable women. In a sense, they too are indirect victims of poverty. Impoverishment has also forced many Africans, poor or less poor, into new forms of economic activity and social interaction. These in turn have become the continental arteries for the HIV pandemic.
There are parallels here with how the development schemes of earlier decades contributed to the spread of certain diseases. For example, the Gezira scheme in Sudan created a problem of schistosomiasis, and the Volta River dam in Ghana accentuated the problem of river blindness. Similarly, the economics of labour mobility in contemporary Africa has been a major social vector of HIV transmission.
We may blame individual behaviour, but changing social and economic conditions have put that behaviour in a new and very different, dangerous context Schoepf, The correlation in time between the AIDS pandemic and the austerity measures imposed on Africa by international financial institutions is striking. In the last twenty years, Africa has suffered severe cutbacks in basic services including education and health. In the meantime, economies have been restructured, with growing unemployment, migration in search of work and food, and informal economies and export-oriented trade have grown.
Inequality has grown. And at the same time, the capacity of public service provision to contain the pandemic has suffered. Perhaps equally importantly, structural adjustment programmes have entailed a new, tougher language of economic development in Africa. International donors have placed the primary and overwhelming responsibility for economic failures on African governments themselves.
International focus on basic survival and social security has been conspicuously weak: these tasks have been largely delegated to relief NGOs, rather than lying at the center of international assistance policies. This limited account indicates that poverty and inequality increase the likelihood of some sections of the populace engaging in frequent unsafe sexual intercourse.
If AIDS is the only disaster that threatens, it is likely that individuals and communities will take action against it. But when AIDS is only one disaster among many, it is not the highest priority. There must be individual behavioral change; individuals and communities must protect themselves. The question of traditional religions leads on to the equally important issue of localism. In any issue as sensitive and intimate as HIV transmission, very local belief structures and practices are extremely important. Language is a key issue.
Public education messages are most effective when transmitted in local languages. This demands a level of local connectedness and awareness that is very difficult for an outsider, even from another part of the same country, to achieve.
No single formula can fit all cases perfectly. Each community needs to find its own mechanisms and idioms for responding. How is one to impart the message, to teenage girls, that it is essential to insist on using a condom during first sexual intercourse?
The cultural archive of African societies contains responses to many historical epidemics and famines. Strategies include moving away, isolating those who are infected, conserving resources, waiting, responding to the loss of life by increasing fertility. This cannot be imposed, it cannot be formulated as part of a public policy initiative, it must emerge from national debate.
Traditions of care, obligation, hospitality, inclusion, socially-responsible leadership, solidarity of youth, etc. Leadership at national and international political levels, effectiveness in developing and implementing public policy, must be combined with ability to allow and promote free expression and debate, and sensitivity to very local and particular concerns. This paper attempts to keep terminology to the minimum: the aim is not to test sociological hypotheses but to explore possibilities for social change.
But we need to identify several major concepts:. Leadership is a position of power and authority, with corresponding responsibility, over an organized institution, collectivity or community.
For leadership to be more than simply presiding over an inert group or organization, it must also have the component of agency: the ability to affect change or, to resist change. Leadership is thus not a matter of isolated action and existence but leadership always, by definition, requires a group of people it responds to. There is never leadership without the led. To cater to and maintain the led is what constituted leadership. Leadership is also a form of guidance towards a particular goal, leaders have an impact on the way their constituency sees and responds to the world.
Thus they help to define public opinion.