Abstract
We study the long-term determinants of the high rates of HIV infection in sub-Saharan Africa, particularly among women, with a focus on family structure and sexual behavior as shaped by the demographic shock following the transatlantic slave trade. First we show that, in clusters where polygyny is more widespread, HIV infection rates are higher. By instrumenting polygyny with the demographic shock we can also establish that this link is causal. Next we turn to the channels through which polygyny is likely to affect HIV infection by focusing on sexual behavior, as captured by the intensity of sexual activity and the frequency of extramarital partnerships. We document relevant gender differences in behavior: in clusters affected by a larger demographic shock men (but not women) display a more intense sexual activity, while women (but not men) are more likely to engage in extramarital partnerships. We employ these findings to instrument sexual behavior when estimating its influence on HIV infection and we show that clusters exhibiting more frequent female extramarital partnerships are affected by significantly higher infection rates. We interpret our results as follows. The demographic shock induced by the slave trade represents a primordial risk factor which is still shaping contemporary family structure and sexual behavior. Polygyny is associated with unsatisfying marital relationships, particularly for women, with consequent female infidelity and an increased risk of infection, which is further multiplied for women co-habiting within polygynous households.
Highlights
HIV/AIDS is one of the most deathly diseases in Africa
Barriers of access to services, poor education, lack of economic security, and unequal gender norms involving concepts of masculinity that induce unsafe sexual behavior are some of the reasons which can explain this peculiarity within sub-Saharan Africa (UNAIDS, 2013)
We find that higher infection rates can be explained by the combined influence of polygyny, i.e., men's decisions to take more than one wife, and women’s infidelity, since the fact that unsatisfied women engage in extramarital partnerships increases the rate of transmission of HIV
Summary
HIV/AIDS is one of the most deathly diseases in Africa. According to the WHO (2012) in 2012 almost 36 million people around the world lived with HIV and 1.6 million people died of AIDS. What is peculiar about sub-Saharan Africa is that HIV is much more common among women, who represent nearly 60% of the infected, and 75% of the infected in the 17-24 year-old age group, with young women having a probability of being infected which is almost 5 times larger than for young men (Rehle et al, 2007; Wang, 2010). Barriers of access to services, poor education, lack of economic security, and unequal gender norms involving concepts of masculinity that induce unsafe sexual behavior are some of the reasons which can explain this peculiarity within sub-Saharan Africa (UNAIDS, 2013). In this paper we look at the long-term determinants of HIV infection and its gendered pattern with a focus on the potential influence of the demographic shock that hit Africa as a consequence of the transatlantic slave trade. Our present contribution is to uncover the further consequences of the demographic shock for HIV infection as well as for sexual behavior in the present day
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