Damien de Walque's blog

Prevention strategies have had limited impact on the trajectory of the HIV/AIDS epidemic. New, innovative approaches to behavioral change are needed to stem the epidemic.

In a joint effort with many colleagues, and in collaboration with the Ifakara Health Institute in Tanzania and, the University of California at Berkeley, we launched a study with the acronym RESPECT (“Rewarding STI Prevention and Control in Tanzania”).

We started with an observation:  Conditional cash transfers (CCTs) have been used successfully to promote activities that are beneficial to the participants such as school attendance  and health check-ups for children.  The Tanzanian experiment asks whether CCTs can be used to prevent people from engaging in activities that are harmful to themselves and others, such as unsafe sex. This is a controversial idea.

Swaziland and Lesotho are among the countries with the highest HIV prevalence in the world.
Recent nationally representative estimates reveal an adult HIV prevalence equal to 26% in Swaziland¹ and 23.2% in Lesotho².

These countries have two other main features in common: they are small countries bordering South Africa and, during the past decades, they were exposed to massive recruitment efforts to work in South African mines. For more than a century, about 60 percent of those employed in the mining sector in the Republic of South Africa were migrant workers from Lesotho and Swaziland³.

In a recent paper⁴ with Lucia Corno, we started from this set of facts and investigated whether the massive percentage of migrant workers employed in the South Africa’s mining industry for a long period might be one of the main explanations for the high HIV prevalence observed in Swaziland and Lesotho.

Under-5 mortality is often used—perhaps implicitly—as a measure of “population health”.  But what is happening to adult mortality in Africa? 

In a recent working paperⁱ , we combine data from 84 Demographic and Health Surveys from 46 countries, and calculate mortality based on the sibling mortality reports collected from female respondents aged 15-49. The working paper is available here and the database we used for the analysis can be found here.

We find that adult mortality is quite different from child mortality (under-5 mortality)¹.   This is perhaps obvious to most readers, but is clearly illustrated in figure 1. While in general both under-5 and adult mortality decline with per-capita income, and over time, the latter effect is much smaller for adult mortality, which has barely shifted in countries outside Africa between 1975-79 and 2000-04.

But in sub-Saharan Africa, contrary to under-5 mortality everywhere and to adult mortality outside of Africa, adult mortality increased between 1975-79 and 2000-04 and the relationship between adult mortality and income became positive in Africa as indicated by the upward sloping line in 2000-04.

This diverging and dramatic trend for sub-Saharan Africa is mainly driven by the HIV/AIDS epidemic. 

Sexual transmission is considered to be the main source of the spread of the HIV/AIDS epidemic in Africa¹.

The pervasive if unstated belief in the HIV/AIDS community is that males are primarily responsible for spreading the infection among married and cohabiting couples. A U.N. report entitled Women and HIV/AIDS: Confronting the Crisis reported: “Nearly universally, cultural expectations have encouraged men to have multiple partners, while women are expected to abstain or be faithful.” and “Faithfulness offers little protection to wives whose husbands have several partners or were infected before they were married.”

L’école, une opportunité rare, objet de choix stratégiques dans les familles.

“Ici, pour les parents, l’école n’est pas une priorité”. Cette réflexion, empreinte de fatalisme, est souvent entendue comme explication des taux de fréquentation scolaire faibles dans certaines régions d’Afrique. Une étude récente menée dans la Province du Nahouri au Burkina Faso¹  suggère que la situation est plus complexe.