Race, Sex, and the Neglected Risks for Women and Girls in Sub-Saharan Africa

Global AIDS policy has failed to stop the spread of HIV in sub-Saharan Africa because prevention programs are limited by an unscientific theory of disease causation, which assumes that differences in HIV prevalence among populations are adequately explained by variation in rates of unsafe sexual behaviors. But differences in sexual behavior cannot explain 250-fold differences in HIV prevalence among countries and increasing divergence in incidence. Such disparities point to biological characteristics of the pathogen, the host, and the environment, all of which influence individual risk of infection and the spread of infectious diseases in populations. This paper explores the ways in which Western constructions of race and sexuality have drawn attention to sexual behavior alone and away from scientific evidence of biological risk factors that increase HIV transmission in poor populations. Much of the discussion addresses sub-Saharan Africa, but the biological implications could apply to poor people in other regions.