, Volume 77, Issue 4, pp 505–523 | Cite as

HIV and AIDS in Africa: a geographic analysis at multiple spatial scales

  • Ezekiel Kalipeni
  • Leo C. Zulu


This study offers an alternative method rooted in GIS techniques and spatial analysis to estimate HIV/AIDS prevalence over space from an incomplete surveillance data set and explain the variation of those estimates. The results clearly show that the HIV/AIDS epidemic is complex and that it is interconnected with other geographic, historical, economic and cultural phenomena which help explain its spatial spread and variation. The regression models which were developed in this paper illustrated that variables which measure the historical context of colonialism such as resource exploitation and labor migration, gender, culture, contemporary global forces, poverty and disease burden have all contributed variously to the rapid spread of this disease both in space and time. The policy implication is that concentrating on behavior change or therapy alone may not turn the epidemic around. The attack needs to be multifaceted and interdisciplinary taking into consideration the context and the economic and social realities at multiple spatial scales.


HIV and AIDS Geospatial analysis HIV/AIDS drivers 



We are grateful to Centra Technology, Inc. for providing the data set that led to the geographic and statistical analysis and construction of the maps contained in this paper. We also wish to acknowledge the valuable comments we received from the individuals who graciously reviewed this paper. Their comments were very constructive and resulted in a much stronger paper.


  1. Abrahamsen, R. (1997). Gender dimensions of AIDS in Zambia. Journal of Gender Studies, 6(2), 177–189.CrossRefGoogle Scholar
  2. Auvert, B., Taljaard, D., Lagarde, E., Sobngwi-Tambekou. J., Sitta, R., et al. (2005). Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial. PLoS Medicine, 2(11), e298-e, 1112–1122. Accessed 17 August 2008.
  3. Bailey, T. C., & Gatrell, A. C. (1995). Interactive spatial data analysis (2nd ed.). Harlow: Longman.Google Scholar
  4. Bailey, R. C., Moses, S., Parker, C. B., Agot, K., Maclean, I., Krieger, J. N., et al. (2007). Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet, 369(9562), 643–656.CrossRefGoogle Scholar
  5. Berkman, L. F., & Kawachi, I. (2000). Social epidemiology. Oxford: Oxford University Press.Google Scholar
  6. Bongaarts, J., Reining, P., Way, P., & Conant, F. (1989). The relationship between male circumcision and HIV infection in African population. AIDS, 3(6), 373–377.CrossRefGoogle Scholar
  7. Bonner, K. (2001). Male circumcision as an HIV control strategy: Not a ‘natural condom’. Reproductive Health Matters, 9(18), 143–155.CrossRefGoogle Scholar
  8. Brockerhoff, M., & Biddlecom, A. E. (1999). Migration, sexual behavior and the risk of HIV in Kenya. International Migration Review, 33(4), 833–856.CrossRefGoogle Scholar
  9. Bwayo, J. (1994). Human immunodeficiency virus infection in long-distance truck drivers in East Africa. Archives of Internal Medicine, 154(12), 1391–1396.CrossRefGoogle Scholar
  10. Caldwell, J. (1994). The neglect of an epidemiological explanation for the distribution of HIV/AIDS in sub-Saharan Africa: Exploring the male circumcision hypothesis. In J. G. Cleland & P. O. Way (Eds.), AIDS impact and prevention in the developing world: Demographic and social science perspectives (pp. 23–46). Canberra: Health Transition Centre and National Centre for Epidemiology and Population Health, Australian National University.Google Scholar
  11. Campbell, C. (1997). Migrancy, masculine identities and AIDS: The psychosocial context of HIV transmission on the South African gold mines. Social Science and Medicine, 45(2), 273–281.CrossRefGoogle Scholar
  12. Central Statistical Agency [Ethiopia] and ORC Macro. (2006). Ethiopia demographic and health survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro. Accessed 25 August 2008.
  13. Charmes, J., & Wieringa, S. (2003). Measuring women’s empowerment: An assessment of the gender-related development index and the gender empowerment measure. Journal of Human Development, 4(3), 419–435.CrossRefGoogle Scholar
  14. Chirwa, W. C. (1998). Aliens and AIDS in southern Africa: The Malawi-South Africa debate. African affairs, 97(386), 53–81.CrossRefGoogle Scholar
  15. Connor, E. M., Sperling, R. S., & Gelber, R. (1994). Protocol 076: Reduction in maternal-infant transmission of HIV type 1 with zidovudine treatment. New England Journal of Medicine, 331(18), 1173–1180.CrossRefGoogle Scholar
  16. Decosas, J., Kane, F., Anarfi, J. K., Sodji, K. D., & Wagner, H. U. (1995). Migration and AIDS. Lancet, 346(8978), 826–828.CrossRefGoogle Scholar
  17. Degregori, M. C. A. (2007). Critical medical anthropology perspectives on male circumcision to prevent HIV. In Medicus. Mundi (Ed.), Women, AIDS and access to health care in sub-Saharan Africa: Approaches from the social sciences (pp. 127–138). Barcelona: Medicus Mundi Catalunya.Google Scholar
  18. Delay, P. (2004). Gender and monitoring the response to HIV/AIDS pandemic. Emerging Infectious Diseases, 10(11), 1979–1983.CrossRefGoogle Scholar
  19. Diallo, M. O., Ettiene-Traore, V., Maran, M., Kouadio, J., Brattegard, K., Makke, A., et al. (1997). Sexually transmitted diseases and human immunodeficiency virus infections in women attending an antenatal clinic in Abidjan, Cote d’Ivoire. International Journal of STD and AIDS, 8(10), 636–638.CrossRefGoogle Scholar
  20. Dijkstra, A. G., & Hanmer, L. (2000). Measuring socio-economic gender inequality: Toward an alternative to the UNDP gender-related development index. Feminist Economics, 6(2), 41–75.CrossRefGoogle Scholar
  21. Duffy, L. (2005). Culture and context of HIV prevention in rural Zimbabwe: The influence of gender inequality. Journal of Transcultural Nursing, 16(1), 23–31.CrossRefGoogle Scholar
  22. Fellman, J., Getis, A., & Getis, J. (2001). Human geography: Landscapes of human activities. Boston, MA: McGraw Hill.Google Scholar
  23. Ferguson, A. G., & Morris, C. N. (2007). Mapping transactional sex on the Northern Corridor highway in Kenya. Health & Place, 13(2), 504–519.CrossRefGoogle Scholar
  24. Gerdtham, U.-G., & Löthgren, M. (2002). New panel results on cointegration of international health expenditure and GDP. Applied Economics, 34(13), 1679–1686.CrossRefGoogle Scholar
  25. Girdler-Brown, B. (1998). Eastern and southern Africa. International Migration Review, 36(4), 513–551.CrossRefGoogle Scholar
  26. Gisselquist, D. (2004). Impact of long-term civil disorders and wars on the trajectory of HIV epidemics in sub-Saharan Africa. Journal of Social Aspects of HIV/AIDS, 1(2), 114–127.CrossRefGoogle Scholar
  27. Greene, R. W. (2001). Governing reproduction: Women’s empowerment and population policy. Communication Abstracts, 24(1), 3–147.Google Scholar
  28. Haour-Knipe, M., & Rector, R. (1996). Crossing borders: Migration, ethnicity, and AIDS. Bristol, PA: Taylor and Francis.Google Scholar
  29. Iliffe, J. (2006). The African AIDS epidemic: A history. Athens, Ohio: Ohio University Press.Google Scholar
  30. Kalipeni, E., & Mbugua, N. (2005). A review of prevention efforts in the fight against HIV and AIDS in Africa. Norwegian Journal of Geography, 59(1), 26–36.Google Scholar
  31. Kalipeni, E., & Oppong, J. (1998). The refugee crisis in Africa and implications for health and disease: A political ecology approach. Social Science and Medicine, 46(12), 1637–1653.CrossRefGoogle Scholar
  32. Kalipeni, E., & Zulu, L. (2008). Using GIS to Model and Forecast HIV/AIDS Rates in Africa, 1986–2010. Professional Geographer, 60(1), 33–53.CrossRefGoogle Scholar
  33. Krabacher, T., Kalipeni, E., & Layachi, A. (2009). Global studies. Africa. Boston: McGraw-Hill Contemporary Learning Series.Google Scholar
  34. Kreiss, J., Koech, D., Plummer, F., Holmes, K., Lightfoote, M., Piot, P., et al. (1986). AIDS virus infection in Nairobi prostitutes: Spread of the epidemic to East Africa. New England Journal of Medicine, 314(7), 414–418.CrossRefGoogle Scholar
  35. Lau, C., & Muula, A. S. (2004). HIV/AIDS in sub-Saharan Africa. Croatian Medical Journal, 45(4), 402–414.Google Scholar
  36. LeVine, R. A., LeVine, S. E., & Schnell, B. (2002). ‘Improve the women’: Mass schooling, female literacy, and worldwide social change. Educational Administration Abstracts, 37(1), 3–136.Google Scholar
  37. Lurie, P., Hintzen, P. C., & Lowe, R. A. (2004). Socioeconomic obstacles to HIV prevention and treatment in developing countries: The role of the international monetary fund and the world bank. In E. Kalipeni, S. Craddock, J. R. Oppong, & J. Ghosh (Eds.), HIV/AIDS in Africa: Beyond epidemiology (pp. 204–212). Oxford: Blackwell.Google Scholar
  38. Lyons, M. (2004). Mobile populations and HIV/AIDS in East Africa. In E. Kalipeni, S. Craddock, J. R. Oppong, & J. Ghosh (Eds.), HIV/AIDS in Africa: Beyond epidemiology (pp. 175–190). Oxford: Blackwell.Google Scholar
  39. MacDonald, D. S. (1996). Notes on the socio-economic and cultural factors influencing the transmission of HIV in Botswana. Social Science and Medicine, 42(9), 1325–1333.CrossRefGoogle Scholar
  40. Moses, S., Bradley, J. E., Nagelkerke, N. J. D., Ronald, A. R., Ndinya-Achola, J. O., & Plummer, F. A. (1990). Geographical patterns of male circumcision practices in Africa: Association with HIV prevalence. International Journal of Epidemiology, 19(3), 693–697.CrossRefGoogle Scholar
  41. Ndinya-Achola, J. O., Ghee, A. E., Kihara, A. N., Krone, M. R., Plummer, F. A., Fisher, L. D., et al. (1997). High HIV prevalence, low condom use and gender differences in sexual behavior among patients with STD-related complaints at a Nairobi primary health care clinic. International Journal of STD and AIDS, 8(8), 506–514.CrossRefGoogle Scholar
  42. Openshaw, S. (1984). The modifiable areal unit problem. Norwich: GeoBooks. Concepts and techniques in modern geography 38.Google Scholar
  43. Oppong, J. R. (1998). A vulnerability interpretation of the geography of HIV/AIDS in Ghana, 1986–1995. Professional Geographer, 50(4), 437–448.CrossRefGoogle Scholar
  44. Pickering, H., Okongo, M., Ojwiya, A., Yirrell, D., & Whitworth, J. (1997). Sexual networks in Uganda: mixing patterns between a trading town, its rural hinterland and a nearby fishing village. International Journal of STD and AIDS, 8(8), 495–500.CrossRefGoogle Scholar
  45. Plummer, F. A., Moses, S., & Ndinya-Achola, J. (1991). Factors affecting female to male transmission of HIV-1: Implications of transmission dynamics for prevention. In L. C. Chen, J. S. Amor, & S. J. Segal (Eds.), AIDS and women’s reproductive health (pp. 35–45). New York: Plenum.CrossRefGoogle Scholar
  46. Quinn, T., Wawer, M., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., et al. (2000). Viral load and heterosexual transmission of human immunodeficiency virus type 1. New England Journal of Medicine, 342(13), 921–927.CrossRefGoogle Scholar
  47. Rushing, W. A. (1995). The AIDS epidemic: Social dimensions of an infectious disease (pp. 59–90). Boulder, CO: Westview Press.Google Scholar
  48. Schoepf, B. G. (1993). Gender, development, and AIDS: a political economy and culture framework. Women and International Development Annual, 3, 53–85.Google Scholar
  49. Seeley, J., Grellier, R., & Barnett, T. (2004). Gender and HIV/AIDS impact mitigation in sub-Saharan Africa: Recognizing the constraints. Journal of Social Aspects of HIV/AIDS, 1(2), 87–98.CrossRefGoogle Scholar
  50. Shannon, G. W., Pyle, G. F., & Bashshur, R. (1991). The Geography of AIDS: Origins and course of an epidemic. New York: Guilford Press.Google Scholar
  51. Stillwaggon, E. (2001). AIDS and poverty in Africa. Nation, 272(20), 22–25. Accessed 19 July 2007.
  52. Stillwaggon, E. (2002). HIV/AIDS in Africa: Fertile terrain. Journal of Development Studies, 38(6), 1–22.CrossRefGoogle Scholar
  53. Stillwaggon, E. (2003). Racial metaphors: Interpreting sex and AIDS in Africa. Development and Change, 34(5), 809–832.CrossRefGoogle Scholar
  54. Tastemain, C., & Coles, P. (1993). Can a culture stop AIDS in its tracks. New Scientist, 139(Sept.1), 13–14.Google Scholar
  55. UNAIDS. (2004). 2004 Report on the global AIDS epidemic. Geneva: UNAIDS.Google Scholar
  56. UNAIDS. (2008). 2008 Report on the global AIDS epidemic. Geneva: Joint United Nations Program on HIV/AIDS (UNAIDS) 2008. Accessed 31 December 2008.
  57. Unwin, D. J. (1996). GIS, spatial analysis and spatial statistics. Progress in Human Geography, 20(4), 441–540.CrossRefGoogle Scholar
  58. Wasserheit, J. N. (1992). Epidemiological synergy: Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sexually Transmitted Diseases, 19(2), 61–77.Google Scholar
  59. Waterston, A. (1997). Anthropological research and the politics of HIV prevention: Towards a critique of policy and priorities in the age of AIDS. Social Science and Medicine, 44(9), 1381–1391.CrossRefGoogle Scholar
  60. Williams, B. G., Lloyd-Smith, J. O., Gouws, E., Hankins, C., Getz, W. M., et al. (2006). The potential impact of male circumcision on HIV in sub-Saharan Africa. PLoS Medicine 3(7), e262, 1032-1040. doi: 10.1371/journal.pmed.0030262. Accessed 30 June 2008.
  61. Wilson, F. (1976). International migration in southern Africa. International Migration Review, 10(4), 451–487.CrossRefGoogle Scholar
  62. Yeboah, I. E. A. (2007). HIV/AIDS and the construction of Sub-Saharan Africa: Heuristic lessons from the social sciences for policy. Social Science and Medicine, 64(5), 1128–1151.CrossRefGoogle Scholar
  63. Zuma, K., Gouws, E., Williams, B., & Lurie, M. (2003). Risk factors for HIV infection among women in Carletonville, South Africa: Migration, demography and sexually transmitted diseases. International Journal of STD and AIDS, 14(12), 814–817.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.National Science FoundationArlingtonUSA
  2. 2.Department of GeographyMichigan State UniversityMIUSA

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