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Notes -
People have mentioned extremely high rates of promiscuity in Africa - cheating, prostitution, men with multiple families, etc. - and dry sex, which is overrated because of its surprising nature. The main reason for high heterosexual HIV transmission rates is both more pedestrian and more unpleasant. Few African women, particularly in urban slums and to some extent in rural areas, have access to appropriate feminine hygiene stuff (period products, vaginal healthcare, etc.), and as a result many develop long-running vaginal infections, UTIs, or other issues. Because HIV is blood-borne, women with infections or open wounds in their vagina are much more likely to pick it up from sex, and similarly for men having sex with HIV-positive women and contacting their blood. Unfortunately, this is a more difficult problem to solve than anti-retrovirals, and I don't really foresee a similar program to PEPFAR creating much improvement in that respect.
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