The complexity of the HIV/AIDS epidemic stems from its links with all aspects of society and culture.
Social and cultural factors affect not only viral transmission, but also the success of prevention strategies and the compassion with which people living with the virus are treated. A clear understanding of those factors therefore becomes a point of departure for planning the control of the epidemic.

KEY ASPECTS OF THE EPIDEMIC

Three aspects of the HIV epidemic shape the role of social and cultural factors in its propagation and, in turn, modify the culture of the people as they respond to the epidemic: the known modes of transmission; the ways in which the biomedical imperatives of AIDS shape the popular imagery of the epidemic; and the immediate social and cultural responses to the epidemic.

Known Modes of Transmission
Heterosexual transmission accounts for as many as 95% of HIV infections in Nigeria, where having
multiple sexual partners has been a major behavioral factor fueling the epidemic. Consequently, customs and social practices that produce sexual networks have been the major focus of behavioral surveillance. Details of sexual practices such as dry sex also have received attention, with the assumption
that men prefer dry sex (1), leading to trauma that can facilitate HIV transmission (2–4).

Other transmission modes are nonetheless intimately linked to culture as well. High fertility preferences, elevated female infection rates, and low levels of voluntary counseling and testing (VCT) make mother-to-child transmission of HIV an inevitable element of the unfolding epidemic. Inadequate levels of prenatal care and poor delivery services render blood transfusions to pregnant women common. The patchy distribution of HIV screening services expose significant segments of the urban poor and rural populations to unscreened blood. Homosexual transmission may also play a role, as there are anecdotal
reports of men having sex with men within traditional and religious frameworks or in response to demands created by sex tourism in the metropolitan centers. Homosexual practices have also been reported for incarcerated populations (5). Finally, nonsexual traditional practices—particularly male and female circumcision and the custom of creating facial and body markings with shared, non-sterile skin-piercing implements—expose significant numbers of people to infection as well.