HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission

2002 ◽  
Vol 13 (10) ◽  
pp. 657-666 ◽  
Author(s):  
David Gisselquist ◽  
Richard Rothenberg ◽  
John Potterat ◽  
Ernest Drucker
Keyword(s):  
Hiv Transmission ◽  
Sexual Transmission ◽  
Hiv Infections ◽  
Developed Countries ◽  
Sub Saharan Africa ◽  
African Women ◽  
Heterosexual Transmission ◽  
Direction Of Causation ◽  
Sub Saharan ◽  
Hiv Negative

An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behaviour. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%–40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa's HIV epidemic. More research is warranted to clarify risks for HIV transmission through health care.

Assessing the role of anal intercourse in the epidemiology of AIDS in Africa

2003 ◽  
Vol 14 (7) ◽  
pp. 431-436 ◽  
Author(s):  
Stuart Brody ◽  
John J Potterat
Keyword(s):  
Hiv Transmission ◽  
Anal Intercourse ◽  
Sub Saharan Africa ◽  
Heterosexual Transmission ◽  
Health Authorities ◽  
Health Care Practices ◽  
Heterosexual Anal Intercourse ◽  
Public Health Authorities ◽  
Sub Saharan

Public health authorities have long believed that the preponderance of AIDS cases in Africa are attributable to 'heterosexual transmission'; most people silently assume this rubric to indicate penile–vaginal intercourse only. Recent epidemiologic analyses suggest that the majority of HIV cases in sub-Saharan Africa may be due to non-sterile health care practices. The present paper reviews the anthropological, proctologic, and infectious disease literature, and argues that both homosexuality and heterosexual anal intercourse are more prevalent in Africa than has traditionally been believed. The authors hypothesize that perhaps the majority of HIV transmission not accounted for by iatrogenic exposure could be accounted for by unsuspected and unreported penile–anal intercourse. Given the authors' findings, properly conducted studies to measure this HIV transmission vector, while controlling for iatrogenic exposure confound, are clearly warranted in Africa and in countries with similar epidemiologic characteristics.

Let it be sexual: how health care transmission of AIDS in Africa was ignored

2003 ◽  
Vol 14 (3) ◽  
pp. 148-161 ◽  
Author(s):  
David Gisselquist ◽  
John J Potterat ◽  
Stuart Brody ◽  
Francois Vachon
Keyword(s):  
Health Care ◽  
General Population ◽  
Population Studies ◽  
Risk Measures ◽  
Sexual Transmission ◽  
Hiv Infections ◽  
Heterosexual Transmission ◽  
Evidence Based ◽  
General Population Studies ◽  
Direction Of Causation

The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988. We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures. Early studies did not resolve questions about direction of causation (between injections and HIV) and confound (between injections and STD). Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence. We urge renewed, evidence-based, investigations into the proportion of African HIV from non-sexual exposures.

Heterosexual transmission of HIV in Africa: an empiric estimate

2003 ◽  
Vol 14 (3) ◽  
pp. 162-173 ◽  
Author(s):  
David Gisselquist ◽  
John J Potterat
Keyword(s):  
Risk Factors ◽  
Confidence Intervals ◽  
Hiv Transmission ◽  
Sexual Transmission ◽  
African Women ◽  
Heterosexual Transmission ◽  
Hiv Incidence ◽  
Point Estimates

For more than a decade, most experts have assumed that more than 90% of HIV in African adults results from heterosexual transmission. In this exercise, we show how data from studies of risk factors for HIV can be used to estimate the proportion from sexual transmission, and we present our estimates. Calculating two ways from available data, our two point estimates — we do not estimate confidence intervals — are that 25-29% of HIV incidence in African women and 30-35% in men is attributable to sexual transmission; these estimates assume 10% annual epidemic growth. These findings call for reconceptualization of research to more accurately assess routes of HIV transmission.

Cutting-Edge Success in Preventing Heterosexual HIV Transmission in Africa: Voluntary Medical Male Circumcision Has Reached 15 Million Men

2018 ◽  
Vol 30 (3) ◽  
pp. 232-242
Author(s):  
Inon Schenker
Keyword(s):  
Male Circumcision ◽  
Randomized Clinical Trials ◽  
Hiv Transmission ◽  
Hiv Infections ◽  
High Volume ◽  
Sub Saharan Africa ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Sub Saharan ◽  
A Minor

Male circumcision is a minor surgery performed for religious and medical reasons. Three randomized clinical trials demonstrated it could reduce heterosexual HIV transmission from infected females to males by over 60%, paving the way in 2006 for multinational efforts to circumcise 27 million men in sub-Saharan Africa by 2021. It is estimated that by 2030 male circumcision will avert at least 500,000 HIV infections in Africa, saving lives and budgets. Voluntary medical male circumcision (VMMC) of adults and adolescents has challenged policy makers, implementers, funders, and civil society in bringing surgery to the frontline of HIV prevention. Five key challenges are discussed: policy, clinical, demand, supply, and scaling up. A unique Israel-Senegal-South Africa collaboration, which enhanced high-volume (100 VMMCs per day) and high-quality (less than 2% minor adverse events) procedures, is described, highlighting VMMC as one of the most impressive public health collaborative interventions in HIV/AIDS prevention globally.

scholarly journals Characterizing HIV epidemiology in stable couples in Cambodia, the Dominican Republic, Haiti, and India

2015 ◽  
Vol 144 (1) ◽  
pp. 90-96 ◽  
Author(s):  
H. CHEMAITELLY ◽  
L. J. ABU-RADDAD
Keyword(s):  
Dominican Republic ◽  
Hiv Transmission ◽  
Spillover Effect ◽  
Hiv Infections ◽  
Sub Saharan Africa ◽  
Hiv Epidemiology ◽  
High Risk Populations ◽  
Nationally Representative ◽  
The Difference ◽  
Sub Saharan

SUMMARYUsing a set of statistical methods and HIV mathematical models applied on nationally representative Demographic and Health Survey data, we characterized HIV serodiscordancy patterns and HIV transmission dynamics in stable couples (SCs) in four countries: Cambodia, the Dominican Republic, Haiti, and India. The majority of SCs affected by HIV were serodiscordant, and about a third of HIV-infected persons had uninfected partners. Overall, nearly two-thirds of HIV infections occurred in individuals in SCs, but only about half of these infections were due to transmissions within serodiscordant couples. The majority of HIV incidence in the population occurred through extra-partner encounters in SCs. There is similarity in HIV epidemiology in SCs between these countries and countries in sub-Saharan Africa, despite the difference in scale of epidemics. It appears that HIV epidemiology in SCs may share similar patterns globally, possibly because it is a natural ‘spillover’ effect of HIV dynamics in high-risk populations.

scholarly journals The Importance of Regulation in Natural Immunity to HIV

Vaccines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 271
Author(s):  
Laurence Blondin-Ladrie ◽  
Matheus Aranguren ◽  
Kim Doyon-Laliberté ◽  
Johanne Poudrier ◽  
Michel Roger
Keyword(s):  
Sex Workers ◽  
Hiv Transmission ◽  
Inflammatory Responses ◽  
Female Genital Tract ◽  
Hiv Infections ◽  
Sub Saharan Africa ◽  
Natural Immunity ◽  
Heterosexual Intercourse ◽  
Sub Saharan ◽  
Female Commercial Sex Workers

Worldwide, most Human Immunodeficiency Virus (HIV) infections are acquired through heterosexual intercourse, and in sub-Saharan Africa, 59% of new HIV infections affect women. Vaccines and microbicides hold promise for preventing the acquisition of HIV. To this end, the study of HIV highly exposed seronegative (HESN) female commercial sex workers (CSWs), who constitute a model of natural immunity to HIV, provides an exceptional opportunity to determine important clues for the development of preventive strategies. Studies using both female genital tract (FGT) and peripheral blood samples of HESN CSWs, have allowed identifying distinct features, notably low-inflammatory patterns associated with resistance to infection. How this seemingly regulated response is achieved at the initial site of HIV infection remains unknown. One hypothesis is that populations presenting regulatory profiles contribute to the orchestration of potent anti-viral and low-inflammatory responses at the initial site of HIV transmission. Here, we view to update our knowledge regarding this issue.

scholarly journals HIV Prevalence and Correlations in Prisons in Different Regions of the World: A Review Article

2018 ◽  
Vol 12 (1) ◽  
pp. 81-92 ◽  
Author(s):  
Raheleh Golrokhi ◽  
Behnam Farhoudi ◽  
Leila Taj ◽  
Fatemeh Golsoorat Pahlaviani ◽  
Elham Mazaheri-Tehrani ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Sexual Transmission ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
High Rate ◽  
Limited Data ◽  
Hiv Risks ◽  
The World ◽  
Sub Saharan ◽  
Low Prevalence

The prevalence of HIV is substantially higher among prisoners than the general population, while the incidence varies considerably in different regions around the world. If we consider Sub-Saharan Africa as one region with the highest prevalence of HIV, data on African prisoners would be limited. Despite the low prevalence of HIV in the Middle East and North Africa, its incidence is rising in these regions with a few exceptions; there are insufficient data on HIV prevalence in prisons. A similar situation is present in both Pacific and Central Asia as well as in Eastern Europe. A high rate of infection is mainly observed among prisoners in Western and Central parts of Europe, since the data from these are more available than other parts. Nowadays, the sexual transmission mode and tattooing are important ways in HIV risks among prisoners after injecting drug use as the most common route of HIV transmission in all regions. However, it is difficult to compare and analyze the prevalence of HIV among prisoners in different regions regarding the limited data and different methods which they used in collecting data. Eventually, it can certainly be said that prisons are one of the high-risk places for HIV transmission; on the other hand, can be a suitable place for implementing HIV case-finding, linkage to treatment and harm reduction programs.

Vaginal Ring Adherence in Sub-Saharan Africa: Expulsion, Removal, and Perfect Use

2020 ◽  
Author(s):  
Lungwani Muungo
Keyword(s):  
Hiv Prevention ◽  
Hormone Replacement ◽  
Vaginal Ring ◽  
Sub Saharan Africa ◽  
African Women ◽  
Prevention Trials ◽  
Sub Saharan ◽  
Prevention Method ◽  
Prevention Methods ◽  
Hiv Negative

In sub-Saharan Africa, HIV incidence andprevalence remain disproportionately high among women.Vaginal rings (VRs) have been formulated for the deliveryof antiretroviral-based microbicides, and their favorablesafety and tolerability profiles reported in clinical studies.Although the concept of drug release through a VR hasexisted since 1970, and VRs have been marketed since1992 for contraceptive or hormone replacement purposes,VR use as a microbicide delivery system is a novelapplication. This is the first study to evaluate VR adherenceamong African women in the context of its potential use asan HIV prevention method, to examine predictors ofadherence, and to describe clinical or contextual reasonsfor VR removals or nonadherence. This was a randomizedtrial of the safety and acceptability of a placebo VR wornfor 12 weeks in 170 HIV-negative, African women aged18–35 in four clinic sites in South Africa and Tanzania.The findings suggest that adherence to VR use in thecontext of HIV prevention trials in these communitiesshould be high, thereby enabling more accurate assessmentof an active microbicide safety and efficacy.Keywords Vaginal ring ? Adherence ? Sub-SaharanAfrica ? Female-controlled HIV prevention methods ?Microbicide delivery

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