Preventing and Mitigating AIDS in Sub-Saharan Africa -- Copyright -- Acknowledgments -- Contents -- Summary -- NEED FOR IMMEDIATE ACTION -- SOCIETAL CONTEXT OF HIV/AIDS IN AFRICA -- EPIDEMIOLOGY OF THE HIV/AIDS EPIDEMIC -- SEXUAL BEHAVIOR AND HIV/AIDS -- PRIMARY HIV-PREVENTION STRATEGIES -- MITIGATING THE IMPACT OF THE EPIDEMIC -- BUILDING CAPACITY FOR AIDS-RELATED RESEARCH -- CONCLUSION: THE NEED FOR BETTER BEHAVIORAL AND SOCIAL SCIENCE RESEARCH -- Resume -- IL FAUT AGIR SANS TARDER -- CONTEXTE SOCIETAL DU VIH/SIDA EN AFRIQUE -- EPIDEMIOLOGIE DU VIH/SIDA -- COMPORTEMENT SEXUEL ET VIH/SIDA -- STRATEGIES PREVENTIVES DE BASE CONTRE LE VIH -- L'ALLEGEMENT DE L'IMPACT DE L'EPIDEMIE -- MISE SUR PIED D'UNE CAPACITE DE RECHERCHE SUR LE SIDA -- CONCLUSION: BESOIN DE MEILLEURES RECHERCHES EN SCIENCES SOCIALES ET COMPORTEMENTALES -- 1 Introduction -- PURPOSE OF THE REPORT -- BACKGROUND -- Extent of the Epidemic -- Need for Immediate Action -- The Need for Better Behavioral and Social Science Research -- THE PANEL'S TASK -- ORGANIZATION OF THE REPORT -- 2 Societal Context -- SOCIAL STRUCTURE AND FAMILY ORGANIZATION -- SEXUAL BEHAVIOR AND HIV/AIDS -- MOBILITY -- Rural-Urban Migration -- Diffusion via Major Roads -- Civil Unrest and Wars -- MEDICAL AND PROGRAM FACTORS -- ECONOMIC FACTORS -- 3 Epidemiology of the HIV/AIDS Epidemic -- STATUS OF THE EPIDEMIC -- HIV/AIDS Statistics -- Demographics of HIV Infection -- HIV-2 Infection -- MODES OF TRANSMISSION -- Sexual Transmission -- Risk Factors in Sexual Transmission -- HIV and STDs -- Perinatal Transmission -- Parenteral Transmission -- REMAINING GAPS IN KNOWLEDGE -- Limitations of Existing African Behavioral Data -- The Need to Combine Epidemiological and Social/Behavioral Research -- Ethical Issues in STD/HIV Research -- RECOMMENDATIONS -- 4 Sexual Behavior and HIV/AIDS -- SOURCES OF INFORMATION.

QUESTIONS OF METHODOLOGY -- The Issue of Validity -- PATTERNS OF SEXUAL ACTIVITY -- Sexual Initiation and Premarital Intercourse -- Sex Within Marriage or a Stable Union -- Extramarital and Casual Sex -- Commercial Sex -- SEX-RELATED RISK FACTORS -- High Number of Partners/Commercial Sex -- Perceived Risk -- Age -- Education -- Marital Status -- Residence -- Migration -- Sexually Transmitted Diseases -- Circumcision and Traditional Medical Practices -- Alcohol -- SEXUAL PRACTICES AND BELIEFS -- The Notion That Men Need Sex -- Coercive Sex -- Health Beliefs -- Dry Sex -- Oral/Anal Sex -- Homosexuality -- Postpartum and Other Abstinence -- Levirate Marriage -- AIDS AWARENESS -- Modes of Transmission -- Asymptomatic Transmission -- Severity and Perceived Threat -- Attitudes Toward Sufferers -- Testing -- THE ROLE OF CONDOMS -- Condom Use -- Condoms and STD and HIV Prevention -- Attitudes Toward Condoms -- BEHAVIOR CHANGE -- CONCLUSIONS -- RECOMMENDATIONS -- 5 Primary HIV-Prevention Strategies -- BEHAVIOR-CHANGE INTERVENTION PROGRAM DESIGN AND EVALUATION -- Guiding Principles for Behavior-Change Interventions -- INTERVENTION EVALUATION -- A TYPOLOGY OF INTERVENTION PROGRAMS -- Institution-based Programs -- Community-based Programs -- Population-based Programs -- INTERVENTIONS TARGETING SEXUALLY ACTIVE MEN -- Issues -- Target Population -- Types of Strategies and Programs -- Case Study -- Lessons Learned -- INTERVENTIONS TARGETING SEXUALLY ACTIVE WOMEN -- Issues -- Target Population -- Types of Strategies and Programs -- Case Study: An Intervention Targeted to Commercial Sex Workers -- Case Study: A Community-based Intervention -- Lessons Learned -- INTERVENTIONS TARGETING YOUTH -- Issues -- Target Population -- Types of Strategies and Programs -- Case Study -- Lessons Learned -- PERINATAL TRANSMISSION -- RECOMMENDATIONS.

ANNEX 5-1 SELECTED AIDS INTERVENTION PROGRAMS IN AFRICA -- 6 Mitigating the Impact of the Epidemic -- INTRODUCTION -- IMPACT ON PERSONS WITH HIV -- Stigmatization of the Seropositive -- Economic Hardship Due to HIV -- Care for People with AIDS -- IMPACT ON EXTENDED FAMILY MEMBERS AND FRIENDS -- Caring for Survivors: Children and the Elderly -- INDIRECT IMPACT OF AIDS ON THE REST OF SOCIETY -- Demographic Impact -- Morbidity and Mortality -- Anticipated Future Impact -- Relationship Between Seroprevalence and Mortality Rates -- Economic Impact -- HIV/AIDS and Per Capita Income Growth -- Effect of the Epidemic on Sectors of Economic Activity -- Impact of the Epidemic on Firms -- Summary -- ATTEMPTS TO MITIGATE THE IMPACT OF HIV/AIDS -- Intended Beneficiary -- Providers of Mitigation Assistance -- Types of Mitigation Help Being Provided -- RECOMMENDATIONS -- ANNEX 6-1: A BRIEF SURVEY OF NONGOVERNMENTAL ORGANIZATIONS IMPLEMENTING MITIGATION PROGRAMS IN SUB-S ... -- 7 Building Capacity for AIDS-Related Research -- INTRODUCTION -- Problem Statement -- Data Sources -- CONSTRAINTS ON RESEARCH IN SUB-SAHARAN AFRICA -- Insufficient/Poorly Allocated Funds -- Inadequate Manpower -- Unintended Negative Consequences of Donor Policies -- Inadequate Coordination -- Lack of Information on Previous and Ongoing Research Efforts -- Lack of Research-Needs Assessment and Difficulty of Coordinating Funding from Multiple Sources -- Lack of Cooperation Among Donor Agencies -- Harsh Environment for Social and Behavioral Research -- Unfavorable Political Climate -- Decline of Higher-Education Systems in Sub-Saharan Africa -- Inadequate Infrastructure -- Economic Weakness -- Weak Policy Support for the Health Sector -- Low Value Placed on Social and Behavioral Research -- RECOMMENDATIONS -- References.

APPENDIX A Panel Visits to Three African Countries: January 20-February 12, 1995 -- INTRODUCTION -- ZAMBIA JANUARY 23-27, 1995 -- Overview of Current HIV/AIDS Situation -- History of AIDS-Prevention Efforts -- Ongoing Prevention and Mitigation Initiatives -- Workplace Peer Education and Counseling -- Traditional Healer Component -- Programs for Orphans -- The State of Social and Behavioral Research -- TANZANIA JANUARY 30-FEBRUARY 3, 1995 -- Overview of Current HIV/AIDS Situation -- History of AIDS-Prevention Efforts -- Ongoing Prevention and Mitigation Initiatives -- Components of the Tanzania AIDS Project -- The Nongovernmental Organization Strategy -- Social and Economic Mitigation of AIDS -- The State of Social and Behavioral Research -- CAMEROON -- Overview of Current HIV/AIDS Situation -- History of AIDS-Prevention Efforts -- Ongoing Prevention and Mitigation Efforts -- Overview -- AIDSCAP -- The State of Social and Behavioral Research -- IRESCO -- FOCAP -- OVERALL THEMES -- REFERENCES -- PEOPLE CONTACTED -- Zambia -- Tanzania -- Cameroon -- APPENDIX B Biographical Sketches -- Index.