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The socio-economic determinants of the AIDS epidemic in South Africa--a cycle of poverty.

The many links between poverty and AIDS in Africa make prevention problematic. Even without supportive social conditions the biologic nature of the infection is complex and malignant. In South Africa HIV/AIDS has appeared recently but apartheid and its impact on traditional Black culture as well as its contribution to poverty and the high levels of migration and mobility assure that AIDS will be devastating in South Africa. Prevention of AIDS is hampered by migration the loss of kin relations and support prostitution gender inequalities limited access to health care illiteracy urban violence and limited opportunities for leisure and entertainment. The links between poverty and AIDS are also promoted through job and income loss rejection discrimination and ill health. Most economies even subsistence economies need a cash-based economy. Migrants moving for cash income encounter loss of friends kin traditions places of shelter culture and a role in the community. Leaving home can contribute to a loosening of personal and sexual constraints in a mundane and hostile environment. Sexually transmitted diseases are rampant under these conditions. Women in poor circumstances sell sex as a commodity for their own or their childrens survival. Gender inequalities limit opportunities for women to support themselves and to maintain control over their sex lives. AIDS affects all classes. The seriousness and the silent nature of AIDS makes it difficult to communicate to illiterates or the poorly educated. Social changes must be made. Programs of AIDS prevention must be established in addition to socioeconomic changes in order to impact on the South African mentality of fatalism and despondency.