The contribution of harmful traditional practices to HIV transmission among adolescent and adult females in Sub-Saharan Africa: a victimological approach

Abstract Background In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international efforts have aimed at reducing sexual transmission. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban-rural disparities. Methods HIV prevalence data were obtained for 30 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Countries were grouped into 2% or higher and lower than 2% HIV prevalence among girls 15–19 years in the first survey. Country medians and average annual rates of changes were used to summarize the trends. Data on HIV incidence at ages 15–24 and prevalence at 5–9 and 10–14 years were reviewed from 11 recent national surveys. Trends in urban-rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15–24 years, using the same surveys. Results HIV prevalence among girls 15–19 years declined in the higher HIV prevalence group from 5.7–2.6% during 2005–2015, corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1–1.2% in the higher prevalence group. Smaller changes were observed in the lower prevalence country group where median HIV prevalence among girls decreased from 0.7–0.4% (average annual rate of reduction 5.9%). Girl – boy differences at 10–14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15–24 had at least 1.5 times higher HIV prevalence than their rural counterparts, and all experienced similar declines during 2005–2015. Condom use and HIV testing increased among adolescents in both higher and lower prevalence countries, but indicators of sexual activity showed little change over time. Conclusions HIV prevalence declined in almost all countries during the last decade, in both urban and rural settings, for both sexes. The urban-rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in eastern and southern African countries.

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Collecting the essence of man: semen collection for HIV transmission studies in sub-Saharan Africa

Sexually Transmitted Infections ◽

10.1136/sti.2004.012104 ◽

2005 ◽

Vol 81 (2) ◽

pp. 185-186 ◽

Cited By ~ 1

Author(s):

M A Price

Keyword(s):

Hiv Transmission ◽

Sub Saharan Africa ◽

Semen Collection ◽

Sub Saharan ◽

Transmission Studies

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Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Sexual Health ◽

10.1071/sh13094 ◽

2014 ◽

Vol 11 (2) ◽

pp. 126 ◽

Cited By ~ 9

Author(s):

Ying-Ru Lo ◽

Masaya Kato ◽

Nittaya Phanuphak ◽

Masami Fujita ◽

Duong Bui Duc ◽

...

Keyword(s):

Hiv Transmission ◽

Sub Saharan Africa ◽

Treatment As Prevention ◽

The Pacific ◽

Prep Implementation ◽

Sub Saharan ◽

Hiv Acquisition ◽

Operational Issues ◽

Exposure Prophylaxis ◽

Firm Evidence

Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of ‘real world’ effectiveness is still lacking.

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

International Journal of STD & AIDS ◽

10.1258/095646203322025704 ◽

2003 ◽

Vol 14 (7) ◽

pp. 431-436 ◽

Cited By ~ 62

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.

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