Understanding the Southern African ‘Anomaly’: Poverty, Endemic Disease and HIV

The epicentre of the global HIV epidemic is southern Africa. Previous explanations point to migration patterns and highly skewed income distribution, both thought to promote risky sexual behaviour. This study emphasizes the importance of common infectious and parasitic diseases that increase the likelihood of HIV transmission by increasing contagiousness and vulnerability to infection. Using multiple regression analysis on country‐level data, the authors find that socio‐economic variables explain statistically only one‐tenth of the difference in HIV prevalence between southern Africa and other low‐ and middle‐income countries. Measures of five cofactor infections together with the socio‐economic variables, however, explain statistically about two‐thirds of the southern Africa difference in HIV prevalence. They conclude that the relative affluence of countries in southern Africa and historical migration patterns have tended to mask the vulnerability of the majority of their populations who are poor and who have very high prevalence of infectious and parasitic diseases. Those diseases replicate a cycle of poverty that produces biological vulnerability through coinfections. An important implication of this research is that integrating treatment of endemic diseases with other HIV‐prevention policies may be necessary to slow the spread of HIV.