How much do blood exposures contribute to HIV prevalence in female sex workers in sub-Saharan Africa, Thailand and India?

Gisselquist, David

doi:10.1258/095646207781568655

Cited by 4 publications

(3 citation statements)

References 54 publications

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“…Of course, other modes of HIV transmission could be considered as well, such as intravenous drug use or other exposures to infected blood through traditional or medical procedures. 39 However, we could not figure out a typical confounder that could explain the pattern found in this study, and in particular the consistency in OR across countries. Of course, only more information on all types of exposure to HIV could help sorting out this thorny issue.…”

Section: Discussioncontrasting

confidence: 56%

Commercial sex and HIV transmission in mature epidemics: a study of five African countries

Leclerc

Garenne

2008

Int J STD AIDS

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The study compares the association between using the services of commercial sex workers and male HIV seroprevalence in five African countries: Ghana, Kenya, Lesotho, Malawi and Rwanda. The HIV seroprevalence among men who 'ever paid for sex' was compared with controls who 'never paid for sex'. Results were based on 12,929 eligible men, aged 15-59 years, interviewed in Demographic and Health Surveys. The odds ratio of HIV seroprevalence associated with ever paying for sex was 1.89 (95% confidence interval = 1.57-2.28), with only minor differences by country. The results were stable in multivariate analysis after controlling for available potential cofactors (data on non-sexual routes of transmission were not available). Given the relatively small proportion of men involved, the risk attributable to 'ever paying for sex' remained low: 7.1% in univariate analysis and 4.4% after adjustment, and it varied among countries (range 1.3-9.4%). These results match previous observations that commercial sex seems to play a minor role in the spread of HIV in mature epidemics.

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Section: Discussioncontrasting

confidence: 56%

Commercial sex and HIV transmission in mature epidemics: a study of five African countries

Leclerc

Garenne

2008

Int J STD AIDS

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“…(41) Among patients at STD clinics, cyclic HIV transmission dynamics are possible, and high rates of hepatitis C infection in female sex workers are suggestive of a role for blood exposures in concentrated HIV epidemics. (42) Nevertheless, given the mismatch between modeled and epidemiological estimates of HIV transmission from unsafe medical injections, the true extent of iatrogenic HIV transmission remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Estimating the burden of disease from unsafe injections in India: A cost-benefit assessment of the auto-disable syringe in a country with low blood-borne virus prevalence

Reid

2012

Indian J Community Med

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Background:Unsafe medical injections are a prevalent risk factor for viral hepatitis and HIV in India.Objectives:This review undertakes a cost–benefit assessment of the auto-disable syringe, now being introduced to prevent the spread of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV).Materials and Methods:The World Health Organization methods for modeling the global burden of disease from unsafe medical injections are reproduced, correcting for the concentrated structure of the HIV epidemic in India. A systematic review of risk factor analyses in India that investigate injection risks is used in the uncertainty analysis.Results:The median population attributable fraction for hepatitis B carriage associated with recent injections is 46%, the median fraction of hepatitis C infections attributed to unsafe medical injections is 38%, and the median fraction of incident HIV infections attributed to medical injections is 12% in India. The modeled incidence of blood-borne viruses suggests that introducing the auto-disable syringe will impose an incremental cost of $46–48 per disability adjusted life year (DALY) averted. The epidemiological evidence suggests that the incremental cost of introducing the auto-disable syringe for all medical injections is between $39 and $79 per DALY averted.Conclusions:The auto-disable syringe is a cost-effective alternative to the reuse of syringes in a country with low prevalence of blood-borne viruses.

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“…Despite decades of epidemiologic research on HIV transmission, it remains unclear whether a concentrated epidemic in high-risk groups, such as injection drug users (IDUs) or prostitute women, develops into a generalized epidemic affecting a significant share of the general population. Growing evidence, though, suggests that iatrogenic transmission may be an important component of HIV epidemics in much of Asia and Africa [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

HCV and HIV prevalences strongly correlated in Asian communities with reservoirs of HIV in high-risk groups

Brewer

Khan

2010

J Infect Dev Ctries

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Background: In some Asian communities, HIV epidemics initially concentrated in high-risk groups develop into generalized epidemics, while in others HIV epidemics remain confined to high-risk groups. We examined whether blood exposures in a community, as indicated by hepatitis C virus (HCV) prevalence, can account for the variability in HIV prevalence in Asia. Methodology: We searched the published literature for temporally comparable HCV and HIV prevalence estimates for pregnant women and other "low-risk" population segments in Asian communities with established HIV epidemics in injection drug users or prostitute women. We assessed the correlation between HCV and HIV prevalences in these communities. Results: HCV and HIV prevalences were strongly correlated (r = .97, p < .001). Conclusion: This finding suggests that blood-borne transmission drives generalized HIV epidemics in Asia and highlights the need for appropriately designed investigations of transmission modes.

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How much do blood exposures contribute to HIV prevalence in female sex workers in sub-Saharan Africa, Thailand and India?

Cited by 4 publications

References 54 publications

Commercial sex and HIV transmission in mature epidemics: a study of five African countries

Commercial sex and HIV transmission in mature epidemics: a study of five African countries

Estimating the burden of disease from unsafe injections in India: A cost-benefit assessment of the auto-disable syringe in a country with low blood-borne virus prevalence

HCV and HIV prevalences strongly correlated in Asian communities with reservoirs of HIV in high-risk groups

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