This essay will give the reader an overview of some of the key issues in the social and public health dimensions of HIV/AIDS in sub-Saharan Africa, Asia, Latin America, and the Caribbean. In Africa, HIV/ AIDS is only one of many major concerns facing that continent today. For example, while Rwandans have very high rates of HIV seropositivity, the immediacy of that problem paled by comparison when in the mid-1990s about 800,000 Tutsis, Twa (pygmies), and moderate Hutus were massacred by their Hutu neighbors. The major tribes of Rwanda and Burundi are the Hutu, Tutsi, and Twa. Millions of African men, women, and children die each year from diseases for which vaccines are readily available in North America and Europe. Countless African children die each year from drinking polluted water, because no safe water supply is available.

In Africa, the subordinate role of women and the sexual attitudes of men (the beliefs that women need to be sexually dominated, that if women use a condom they must be promiscuous, and that only men may make the decision to use a condom) have hindered safer sex cam paigns and condom use. Innovative approaches to safer sex messages, however, have proven successful in getting the information out to non-literate populations, such as the theatrical presentations in rural Mali (West Africa) described in one of the reading selections. Peer education in South Africa has also proven effective in getting HIV information across in the workplace.

In the developing world, millions of children who are HIV-negative have been orphaned by the death of their parents. While most are taken in by their grandparents or other relatives, in some cities many children have to fend for themselves, and become homeless street children with no familial supervision or care.

In parts of the developing world where Western medical care is extremely inadequate, and often available only for the wealthy, the traditional healer (curer or shaman, occasionally pejoratively called a ‘‘witch doctor’’) is respected by the people in the community, and has learned how to use local herbs (plants) to effectively treat or cure many health problems. He or she often treats AIDS patients with traditional herbal medicines, and sometimes a little magic, to alleviate symptoms and treat some of the opportunistic infections brought on by AIDS. The traditional healer has been an often overlooked resource for HIV education and AIDS-related treatments, especially in rural areas.

One of our readings on AIDS in Africa discusses the dilemma of a rising population growth rate and the resulting stress on scarce resources, but a declining life expectancy rate that results in a lessened quality of life. Another reading discusses new information which shows that breast-feeding is more dangerous to young children in the developing world than was previously thought, and may require us to rethink our current policy.

HIV is currently spreading at a faster rate in Asia than in Africa, and the number of people with HIV in Asia should soon outnumber those with HIV in Africa. The social conditions in India, where male truckers have unprotected sex (without condoms) with female commercial sex workers for about 28 cents, are similar to those of central and eastern Africa, where the virus has spread rapidly through the population. While governments have expressed dismay over the coming of AIDS, with few exceptions (such as Thailand, which initiated a major and well-funded campaign against AIDS), relatively little has been invested by the nations to stop the spread of HIV. . .

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