The African AIDS Epidemic. John Iliffe

be considered later, but Senegal’s experience, like Nigeria’s, fitted closely into the wider patterns of West Africa, where the great regional variations in HIV prevalence witnessed to an epidemic that had penetrated but not conquered.⁴⁷

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       Causation: A Synthesis

      The HIV-1 epidemic that Kapita Bila had first glimpsed in Kinshasa in the mid-1970s had taken almost exactly ten years to spread and become visible among the African peoples at the three corners of the continent, appearing in Ethiopia, South Africa, and Senegal almost simultaneously in the mid-1980s. Having traced that expansion, it is time to return to President Mbeki’s question: why has Africa had the world’s most terrible HIV/Aids epidemic? An answer must bring together the nature of the virus, the historical sequence of its global expansion, and the circumstances into which it spread, giving particular weight among those circumstances to gender inequalities, sexual behaviour, and impoverishment. Many existing answers perhaps concentrate too exclusively on the circumstances, arguing for the primary importance of either sexual behaviour or poverty.¹