Ezekiel Kalipeni and Leo Zulu of the Department of Geography at the University of Illinois have mapped the disease’s yearly progression from its manifestation in the mid-1980s to the present. These maps appear to confirm assertions that the disease is likely to have started somewhere in Western Equatorial Africa and then spread to East Africa, southern Africa, and West Africa, in that order. The question is: why has the disease found fertile ground in eastern and southern Africa? Why is it so intense and ferocious in southern African countries?

Complex and intricately interlinked factors have contributed to AIDS’s rapid spread in eastern and southern Africa. Once the disease left its box in the jungles of Western Equatorial Africa sometime in the early 1970s, it found fertile ground in eastern and southern Africa. There, many factors put the peoples of these two regions in vulnerable positions. The most critical include the consequences of colonial labor migration patterns; widespread gender inequality; specific cultural contexts; chronic poverty and underdevelopment; frequent political instability; a heavy disease burden; the disease’s stigma; the initial mediocre political responses; a continuing lack of government commitment; and lack of international support.

In South Africa, HIV/AIDS appeared in the early 1990s, introduced by labor migrants from surrounding countries. Here, the culture of international labor migration began during the early days of colonial rule to provide labor for the gold and diamond mining industries. Today, the migrant workers include those from rural areas, foreign workers, truck drivers, young women, and mine workers. Because few job opportunities and very low incomes prevail in rural areas and the surrounding countries, many heads of households, mainly young men, migrate to urban and mining areas to find work. Prolonged separation from their wives encourages miners to have sexual relationships with other women and, for that matter, other men, putting the women or themselves at risk of infection. When they return to their rural homes, those infected with HIV then infect their rural partners. This circular migration typifies the movement patterns of young men and women throughout eastern and southern Africa.

Women’s inferior status in many African countries significantly contributes to the spread of HIV/AIDS as well, because the violence they face and the economic powerlessness they endure are all barriers to HIV prevention. Indeed, the preponderance of HIV positive victims in many African countries are women. It is estimated that 59 percent of women aged 15+ years are HIV positive in comparison to 41 percent of men in sub-Saharan Africa. Other factors that have been blamed for the rapid spread of this epidemic is the presence of diseases such as malaria, trypanosomiasis, onchocerciasis, tuberculosis, sexually transmitted diseases, and poor nutrition, which all compromise the immune system. Clearly, a whole range of macro-level social, political, economic, and cultural factors, not just individual sexual behavior, puts the peoples of Africa in a vulnerable and compromised position in facing the challenges engendered by HIV/AIDS.

Several specific cases drawn from the hundreds of men and women we interviewed in Malawi put a human face on the factors that make people vulnerable to HIV/AIDS. For instance, a young woman (age 17) who had migrated from a rural area to the city of Lilongwe related the following story:

“I was in grade six when my father died in 2002. He used to grow tobacco to pay my school fees. Without him around, and coming from a family of six children, four boys and two girls, I was forced to drop out of school due to lack of school fees. I then migrated to Lilongwe to seek employment. But there is no employment here for an uneducated girl like me. So during the day we go to Lilongwe Market to sell second hand goods, but there is a lot of competition there. At night we try to do all we can do to get a little income. Sometimes we stand by the roadside to see if we can be picked, at other times we go to Lilongwe Hotel, Lingadzi Inn and other such places when there is a conference. If we are lucky in a night we might come back home with about K200 (US$1.50). Some men just use us without paying us and we are too afraid of being beaten to ask for the pay. Life is tough here in the city, but it is even tougher in the village where I came from. From time to time I am able to send a little money to my mother but I don’t reveal how and where I get it.”

It is easy to see that poverty and women’s low status have contributed to this girl’s precarious situation. In further interviews with her, she revealed that she was scared that she might get infected with HIV. She indicated that some men use condoms and others don’t, and she has to oblige in both instances since she needs the money badly. The HIV infection rate among commercial sex workers in Malawi is very high, estimated at 70 percent, since many of the clients are HIV infected and pass the virus on to the girls, and they in turn pass it on to other clients.

A married woman we interviewed clearly articulated her position in the marriage, particularly the factors that make it difficult for women to protect themselves against HIV/AIDS:

“My husband died six months ago. He got so thin, began coughing, developed a rash, much like the rash that affects people with this disease they call AIDS. I know he died of AIDS because I too am losing weight and beginning to cough. I know I have it and I am soon going to die. I have three kids and I am worried as to who will take care of them once I am gone! It is very worrisome. I knew that my husband was moving around with these girls of low morals but I was afraid to ask him to take precautions. I wish I had left him immediately. I knew he was a cheater, but I am powerless, as I come from a poor family. The cattle he paid for the bride-price have all been slaughtered or sold by my parents.”

This woman comes from the northern part of Malawi, where the patrilineal groups such as the Tumbuka ethnic group are predominant. They follow the patrilineal system in which bride-price or lobola is paid for women before marriage. Once a woman is married, divorce is almost impossible to effect, as the bride-price would have to be repaid to the man’s relatives. This custom essentially puts women in bondage to men. Thus, married women, even if they are faithful to their husbands, are at risk of infection from unfaithful husbands.