When Coffee Collapsed: An Economic History of HIV in Uganda

Abstract

In some Ugandan fishing communities, almost half the population lives with HIV. Researchers designate these communities “HIV hotspots” and attribute disproportionate disease burdens to “sex-for-fish” relationships endemic to the lakeshores. In this article, we trace the emergence of Uganda’s HIV hotspots to structural adjustment. We show how global economic policies negotiated in the 1990s precipitated the collapse of Uganda’s coffee sector, causing mass economic dislocation among women workers, who migrated to the lake. There, they entered overt forms of sex work or marriages they may have otherwise avoided, intimate economic arrangements that helped to “engineer the spread of HIV,” as one respondent recounted.