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Three Things You Don't Know About Aids In Africa


WebMD Feature from "Esquire" Magazine

By Emily Oster

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At just twenty-six, economist Emily Oster may have the highest controversies-generated-to-years-in-academia ratio of anyone in her field. That's because, as a Ph.D. student at Harvard, she chose to hop the fence and explore a topic already claimed by doctors, social scientists, and policy wonks: the AIDS epidemic in Africa. Her studies suggest some uncomfortable possibilities-not least that the so-called experts have gotten their approach to the crisis dead wrong.

Now a Becker Fellow at the University of Chicago, Oster continues to blur academic boundaries with further work on AIDS and a volatile new interest: the reported wave of female infanticide in Asia.

When I began studying the HIV epidemic in Africa a few years ago, there were few other economists working on the topic and almost none on the specific issues that interested me. It's not that the questions I want¬ed to answer weren't being asked. They were. But they were being asked by anthropologists, sociologists, and public-health officials.

That's an important distinction. These disciplines believe that cultural differences-differences in how en¬tire groups of people think and act-account for broad¬er social and regional trends. AIDS became a disaster in Africa, the thinking goes, because Africans didn't know how to deal with it.

Economists like me don't trust that argument. We assume everyone is fundamentally alike; we believe circumstances, not culture, drive people's decisions, including decisions about sex and disease.

I've studied the epidemic from that perspective. I'm one of the few people who have done so. And I've learned that a lot of what we've been told about it is wrong. Be¬low are three things the world needs to know about AIDS in Africa.

1. It's the wrong disease to attack. Approximately 6 percent of adults in sub-Saharan Africa are infected with HIV; in the United States, the number is around 0.8 percent. Very often, this disparity is attributed to differences in sexual behavior-in the number of sexual partners, the types of sexual activities, and so on. But these differences cannot, in fact, be seen in the data on sexual behavior. So what actually accounts for the gulf in infection rates?

According to my research, the major difference lies in transmission rates of the virus. For a given unprotected sexual relationship with an HIV-infected person, Africans are between four and five times more likely than Americans to become infected with HIV themselves. This stark fact accounts for virtually all of the difference in population-wide HIV rates in the two regions.

There is more than one reason why HIV spreads more easily in Africa than America, but the most important one seems to be related to the prevalence of other sexually transmitted infections. Estimates suggest that around 11 percent of individuals in Africa have untreated bacterial sexually transmit¬ted infections at any given time and close to half have the herpes virus. Because many of these infections cause open sores on the genitals, transmission of the HIV virus is much more efficient.

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