The Microeconomics of the AIDS Epidemic in Africa

The authors in their book on the AIDS epidemic Private Choices and Public Health: the AIDS Epidemic in an Economic Perspective emphasized the role in the spread and control of the epidemic of voluntary rational choice to engage or refrain from engaging in risky activities. Although they were aware that AIDS is a more serious problem in a number of developing countries especially in countries in sub-Saharan Africa the analysis was limited to the developed world with particular emphasis upon the US. The authors now consider the HIV-1 epidemic in Central and Eastern Africa. Available data indicate that especially in large cities and along major transportation routes AIDS is far more prevalent than in comparable settings in Europe and North America. In contrast to the situation in the US homosexual relations and the sharing of hypodermic needles by IV drug users are minor routes for the spread of the disease in Africa. Instead heterosexual intercourse is estimated to account for 93% of all adult cases while other cases stem from blood transfusions and the transmission of HIV from mother to fetus. Also in contrast to the situation in the US an equal proportion of men and women are infected; female prostitutes are an important source of disease transmission; and the likelihood of being infected with HIV is positively related to income at least in urban areas. The number of new HIV infections appears to not have yet peaked in Africa. Potential policy interventions for the African setting are discussed.