Some Aspects of the Social Context of HIV and Its Effects on Women, Children, and Families
Citation: Palloni, Alberto, Lee, R. (1992) Some Aspects of the Social Context of HIV and Its Effects on Women, Children, and Families.
In this article, a simple framework for the study of the effects of HIV/AIDS on women is suggested. A woman's probability of contraction HIV through sexual transmission at exact age x can be expressed as the product of being expose to contact with infected male(s), G(x), and the conditional probability that if exposed to the contact at that age it will result in infection, F(x). Measurement of these factors is complicated by their dependency on women's characteristics at age x and features of the male population that enters in contact with women at that age. The value of G(x) is the product of (1) the probability of being exposed at age x to any sexual contact at all, and (2) the conditional probability of being exposed to contacts with infected men. The first factor influencing the magnitude of exposure is the timing of entrance into sexual unions or the onset of sexual activity. Exposure to sexual contact is relevant for HIV infection only if, once it begins, it leads to a non-zero probability of contacting infected male(s) the age gap is especially important. A third factor is the level of age-specific prevalence among males, which depends on their frequency of extramarital affairs and population movements (especially male migration). A fourth factor relates to women's roles and socioeconomic characteristics of the family. Finally, the norms regulating remarriage and sexual behavior of widows are also an important mechanism of infection that may affect both women and men. F(x) can also be broken down into (1) the probability of contracting the infection while using protected sexual intercourse, and (2) the probability of using protection and being exposed to the enhancing factors. These factors include being female (male-to-female transmission higher than female-to-male), presence of other STD's, and male/female status inequalities (disparities in the control over the initiation and regular establishment of sexual unions, their consummation, and their termination). The presence of HIV may remain unnoticed for very long periods of time allowing infected individuals to remain active and unknowingly infective and thereby increasing the reproductive values of the virus. However, constraints in the choices that women face produce conditions for a typical incubation process with shorter median incubation times and possibly lower variances due to an interaction between immune system dysfunction and societal rules and mores that increase the likelihood that women will engage in risky behavior. Increases in HIV could have a differential impact on social strata or classes. When HIV is transmitted through heterosexual contact, the maximum levels of sero-prevalence are generally found among young adults and very young children. The levels of paternal and maternal orphanhood at young ages will rise. Increases in adult mortality will also lead to a growing incidence of widow(er)hood. A third consequence is that barring drastic changes in remarriage rules, the dominance of the parental generation will be weakened and the relations between children and grandparents will become more influential. Fourth, in societies with a strong emphasis on descendants and a rigidly enforced norm of high fertility, a sudden upsurge in infant mortality may trigger an adaptive response towards even higher fertility thereby exacerbating women's health problems. Fifth, relatively long incubation periods combined with environments that predispose the population to repeated viral, bacterial, or protozoal infections could lead to health deterioration among the infected population in a measure that is not experienced in areas with different environments. This, in turn, could even further prematurely disable productive individuals. Finally, potential responses, including fosterage and incentives for bridewealth, may further erode women's positions.