Women and AIDS in Africa: demographic implications for health promotion

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Abstract
The population pyramid in most African countries is symmetrical with a broad base. However, in urban areas, one finds a prominent one-sided bulge caused by the migration of young males (aged 18–35) into the cities for employment. The prevalence of HIV infection in urban populations in Africa is highest in the 25–35 year old age-group in males and in the 15–25 year old age-group in females. This difference is due to the fact that on average, sexual partnerships are formed between older men and younger women. The distortion of the urban population profile caused by male migration results in an overall 1:1 female:male prevalence ratio of infection. However, as the epidemic spreads into the larger rural population, the absolute size of the most severely affected younger female population is larger than the size of the older male population, which eventually results in a higher number of infections in women. This excess of female morbidity from HIV infection has important implications for the social and the economic role of women in society. It also adds fuel to an emerging epidemic of paediatric AIDS. Health promotion strategies to address this issue should include: (1) public policies designed to narrow the male:female age-gap of sexual partnership formation; (2) policies addressing the economic migration patterns of the male work force and; (3) policies to narrow the base of the general population pyramid.

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