1. Socio cultural and economic context of HIV/AIDS Chris Desmond MTT August, 2004.

2. I am here today to talk to you about..

3. Promiscuous people!

4. Well if its not just more sex, what is it?

6. Context and risk Poverty and HIV Women and inequality Economic systems Social systems

7. Poverty and HIV Often raised as a cofactor in the spread of HIV How does poverty affect risk? –Education and access to information –STDs Individual and group –Survival strategies Its very expensive being poor So who is most at risk?

8. Women and inequality The status of women in a society and the nature of gender relations plays a role in shaping risk –Different roles for men and women –Power relations –Fueled by poverty and inequality Female vs general poverty

9. Economic systems The nature of a countries or regions economic system shapes peoples lives and the decisions that they can take. –Labour migration –Urban/rural movements Rich and poor side by side

10. Social systems The social structures in a society play a role in determining risk –Definitions of acceptable behaviour –High risk practices –How society adjusts

11. Complex interplay of factors Poverty, inequality, mobility, gender roles, economic and social systems and individual choices interplay to create very different risk environments Trigger and growth factors

12. Context and impact Individuals and communities ability to respond to the epidemic is differential –Access to health facilities –Economic circumstances –Competing concerns These contextual factors influence every aspect of the epidemics impact

13. How should these factors affect our responses?

14. You can’t put a condom on poverty – we already infected

15. How should context shape our responses Prevention Treatment Impacts on children

16. Prevention If HIV/AIDS has such complex risk factors, is information alone enough? –Possibly necessary, but not sufficient What about –Infrastructure as prevention? –Education as prevention? –Social change as prevention?

17. Treatment Effective treatment requires an understanding of the context in which it is being delivered. Consider for example: –Timing –Travel costs –Increased appetite

18. Impacts on children Children infected –Chronically ill –Terminal care Living with ill parents Children in need of care –Institutions (poverty or orphaning?) –Home care with family –Home care with others

19. Summary Risk determined in part by individual behaviours and in part by the context Responding to the epidemic requires a detailed understanding of the context specific factors shaping the epidemic

20. Group work In country groups discuss risk groups in your country –Identify three groups within your country A high risk group A medium risk group A low risk group –For each group explain why you feel they are at the level of risk you associated with them –Outline possible prevention interventions, given the context of your country: who would be responsible for them?