Legal #epidemiology of #HIV in sub-Saharan Africa: How different colonial legacies impact HIV rates in women

Tuesday, February 27, 2018

A recent paper set to be published in the American Economic Review presents an incredibly fascinating analysis on the differences in HIV rates among women in different countries in Africa (the only region in the world where more women than men are living with HIV). The paper finds a significant difference in female HIV rates between countries using a common law system (the legal tradition of the UK) and countries using a civil law system (the tradition of continental Europe), according to each country's colonial legacy (i.e., which European country originally colonized them). My former colleague Mark Leon Goldberg, who featured the paper on his website, UN Dispatch, explains:
The legal traditions mostly developed separately from each other for centuries. This includes how these different legal systems approached property rights for women in general and married women in particular.

In the common law tradition married women did not have any property rights independent from their husbands. That changed in the late 1800s, when the U.K adopted the “Married Women’s Property Act” which allowed married women to own their own separate property in some circumstances. But if the marriage ended by death or divorce, the woman did not have any right to any common property. The civil tradition, by contrast, presumed that married couples owned property jointly, and upon the dissolution of the marriage the woman would be entitled to an equal share.
The paper elaborates on the differences between male and female transmission routes in these countries and explains the epidemiological theory behind them:
The vast majority of HIV infection in Sub-Saharan Africa is through unprotected heterosexual contact (UNAIDS). Male HIV rates on the continent have been linked to high-risk cultural patterns; chief among them traditionally liberal attitudes towards the sexual activity of men. Multiple sexual partners, and both pre-marital and extra-marital sexual activity, is widely tolerated and in some cases even expected.

The high endemic areas are also characterised by disproportionately higher HIV rates for young women relative to their male counterparts. The WHO, the UN, and the World Bank have conjectured that gender inequality plays an important causal role in this ‘feminization’ of the disease. Accordingly, policy has shifted to altering power relations within households, since more than 80% of HIV positive women in Sub-Saharan Africa were infected through their spouse (UNAIDS).
The author then goes on to explain how the existence of women's legal property rights allow women to leverage them to negotiate safer sex practices with a potentially infected spouse:
Property regimes allowing women to leave marriage with a significant share of household assets...can increase female sexual autonomy, even if never exercised. Conversely, regimes limiting women’s control to assets brought to the marriage and to assets acquired personally, limit female power to negotiate sexual interaction with husbands, hence raising female vulnerability to infection. ...women in these countries are more likely to rely on contraception methods that do not require negotiations with their partners, but also do not reduce their risk of contracting HIV, such as injections, the pill, and IUDs. By contrast, women in civil law countries are more likely to use contraception techniques that reduce their chances of contracting HIV, but also require compliance from their partner, such as condoms, abstinence, and the withdrawal method.

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