'Differential poverty rates are responsible for the racial differentials in HIV prevalence in South Africa'; an enduring and dangerous epidemiological urban legend?

Abstract

It is widely held to be axiomatic in South African epidemiological and social science circles that it is not worth comparing the risk factors underpinning the dramatic differences in HIV spread in South Africa’s racial groups, as these are all explained by corresponding differences in socio-economic status. The available evidence, however, suggests that HIV is not simply contoured along lines of socio-economic deprivation; rather, other – largely culturally determined – factors such as the practice and acceptance of multiple concurrent sexual partnerships play a key role. Comparison of sexual behaviours between South Africa’s different races supports the likelihood that cultural and not socio-economic factors are the mediators of differential racial HIV spread. Finally, it is argued that the failure of many South African experts in the study of HIV to consider race as a valid variable for analysis, and allied to this their continued exaggeration of the importance of socio-economic rather than cultural factors, has contributed to the relative failure of our national AIDS strategy.