More than 90 percent of the 1.6 million children orphaned by AIDS in 1997 were African. Women are up to four times more likely than men to be infected through intercourse because they have more exposed genital area and semen carries more of the virus. Wounds from rape, genital circumcision or untreated sexually transmitted diseases also increase the chances for infection. But biological vulnerability is only one aspect of this epidemic, which is a medical disaster melded with a development crisis. In dozens of interviews, African women described how poverty denies them the power to demand that their partners use condoms or even to refuse having sex with men they know are infected.
Sex can become a sort of currency for women with few other economic options.
Being sexually available, inside or outside marriage, brings men home with money for food, children's schooling, clothing, or simply companionship to temper destitution's gloom. He comes home from work. The equation is set early. In a survey by the agency, more than 20 percent of young Nigerian women reported that they were forced to have sex. Two AIDS workers recalled parents who turned a blind eye to such arrangements so that their children had money for education.