Essays on the political economy of the HIV/AIDS epidemic in sub-Saharan Africa

Abstract

Fighting HIV/AIDS remains a priority for sub-Saharan Africa, a region which has been the most severely affected by the disease since the beginning of the epidemic. There is well-documented evidence that the main cause of the rapid spread of HIV in this region is high-risk sexual behavior among the general population. Understanding the motives of this behavior has long been an important research area across a wide range of disciplines. This thesis explores further whether the transmission of HIV in sub-Saharan Africa is associated with factors deeply rooted in culture, history and geography. First, the thesis provides new evidence that a historical and cultural factor like population genetic diversity can contain the transmission of HIV in sub-Saharan Africa. The thesis examines the impact of population genetic diversity on HIV using trade as an external factor, for there is evidence that trade may propagate HIV infections. Using a difference-in-differences strategy, it is found that in countries that are more genetically homogeneous, HIV spreads more easily. The underlying mechanism is genetic and cultural homophily: in societies that are genetically homogeneous, peoples innate preference for partners who are genetically or culturally similar makes forming sexual relationships easier. Genetic and cultural homophily also allows people to trust each other more. Trust in turn is associated with HIV infections as people express their faithfulness towards their partner through trust by ignoring the perceived risk of contracting HIV. Second, the thesis shows that the transmission of HIV in sub-Saharan Africa is associated with a geographical feature. The empirical findings suggest that terrain ruggedness, a measure of the uneven topography of an area, has a positive effect on HIV infections. The causal relationship between terrain ruggedness and HIV can be explained by the following mechanisms. First, terrain ruggedness is negatively associated with historical slave trade in Africa. Rough terrain helped protect those being raided and made it hard to transport slaves from one place to another, thus discouraging slave traders. Secondly, the slave trade matters for the spread of HIV through the conduit of trust. Countries that exported many slaves in the past tend to have societies that are less trusting today; and because low trust is associated with low HIV infections, countries that have high terrain ruggedness could have high rates of HIV infections. The approach to exploring the underlying causes of HIV transmission in sub-Saharan Africa this thesis has taken up is to question why the HIV epidemic in this region is so uneven. The findings suggest that factors other than socio-economic characteristics have a causal effect on HIV incidence. The historical, cultural and geographical determinants of HIV/AIDS in sub-Saharan Africa suggest that some HIV risk factors are not easily in uenced by policies. Moreover, the complexity of the HIV epidemic in sub-Saharan Africa hints that further investigation of the roots of HIV transmission remains a research area worth exploring.