Transmission of HIV via unsafe injection or unsafe sex? Anomalies or misunderstanding?

Mc, Boily; White, Richard G.; Alary, Michel; Cm, Lowndes; Orroth, Kate K.

doi:10.1258/095646204322637308

Cited by 5 publications

(2 citation statements)

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“…Nevertheless, in view of more recent evidence that has emerged, we believe that the evidence for a key role is now overwhelmingly compelling and that alternative explanations are not sufficient to explain the generalized epidemics of sub-Saharan Africa [10][11][12]. Notably, while non-sexual transmission (i.e., iatrogenic or parenteral) likely contributes some new infections in generalized epidemics, empirical evidence continues to mount that non-sexual transmission is not the major contributor of new infections in these epidemics [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 96%

Concurrency revisited: increasing and compelling epidemiological evidence

Mah

Shelton

2011

Journal of the International AIDS Society

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Multiple sexual partnerships must necessarily lie at the root of a sexually transmitted epidemic. However, that overlapping or concurrent partnerships have played a pivotal role in the generalized epidemics of sub-Saharan Africa has been challenged. Much of the original proposition that concurrent partnerships play such a role focused on modelling, self-reported sexual behaviour data and ethnographic data. While each of these has definite merit, each also has had methodological limitations. Actually, more recent cross-national sexual behaviour data and improved modelling have strengthened these lines of evidence. However, heretofore the epidemiologic evidence has not been systematically brought to bear. Though assessing the epidemiologic evidence regarding concurrency has its challenges, a careful examination, especially of those studies that have assessed HIV incidence, clearly indicates a key role for concurrency.Such evidence includes: 1) the early and dramatic rise of HIV infection in generalized epidemics that can only arise from transmission through rapid sequential acute infections and thereby concurrency; 2) clear evidence from incidence studies that a major portion of transmission in the population occurs via concurrency both for concordant negative and discordant couples; 3) elevation in risk associated with partner's multiple partnering; 4) declines in HIV associated with declines in concurrency; 5) bursts and clustering of incident infections that indicate concurrency and acute infection play a key role in the propagation of epidemics; and 6) a lack of other plausible explanations, including serial monogamy and non-sexual transmission. While other factors, such as sexually transmitted infections, other infectious diseases, biological factors and HIV sub-type, likely play a role in enhancing transmission, it appears most plausible that these would amplify the role of concurrency rather than alter it. Additionally, critics of concurrency have not proposed plausible alternative explanations for why the explosive generalized epidemics occurred. Specific behaviour change messaging bringing the concepts of multiple partnering and concurrency together appears salient and valid in promoting safer individual behaviour and positive social norms.

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Section: Introductionmentioning

confidence: 96%

Concurrency revisited: increasing and compelling epidemiological evidence

Mah

Shelton

2011

Journal of the International AIDS Society

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“…This was recently challenged by a group of researchers who hypothesised a larger role (40% or more) for parenteral transmission [5]. However the hypothesis has since been found to be unlikely, both intellectually [6,7] and empirically, when tested in increasing numbers of studies across sub-Saharan Africa [8][9][10][11]. As there will not be a cure or vaccine against HIV for trichomoniasis alone was 12%, and that there were 69 million new cases of these STIs annually [19].…”

Section: Introductionmentioning

confidence: 99%

Curable Sexually Transmitted Infection Treatment Interventions to Prevent HIV Transmission in Sub-Saharan Africa

White¹

2009

TOIDJ

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Abstract:Introduction: Sub-Saharan Africa (Africa) remains the most severely HIV affected region in the world. As there will not be a cure or vaccine against HIV for many years, primary HIV prevention remains key to HIV control. Primary prevention currently includes treatment of curable sexually transmitted infections (STIs). Here, the evidence for curable STI treatment as an HIV prevention strategy in Africa is reviewed.Results: Despite data on the plausible biological mechanisms from laboratory studies and the relative risks from epidemiological studies suggesting that classical STIs do increase the risk of HIV acquisition and transmission, the impact of curable STI treatment on HIV transmission measured in RCTs has varied markedly. Syndromic STI treatment was shown to be an effective strategy in a population with an early HIV epidemic, but neither syndromic STI treatment, nor mass STI treatment were effective in mature HIV epidemics. Among sex workers with relatively low rates of STI, presumptive STI treatment also failed to reduce HIV incidence.Discussion: Rational health policy requires that scarce resources be allocated to interventions with the best costeffectiveness even if relative impact at population level is modest. Curable STI treatment is likely to prevent a decreasing fraction of new HIV infections as the HIV epidemic expands, but, because of increasing HIV incidence it may remain cost-effective for HIV prevention in many African countries.

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The Politics of Uncertainty: The AIDS Debate, Thabo Mbeki and the South African Government Response

Rijn¹

2006

Social History of Medicine

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Transmission of HIV via unsafe injection or unsafe sex? Anomalies or misunderstanding?

Cited by 5 publications

References 0 publications

Concurrency revisited: increasing and compelling epidemiological evidence

Concurrency revisited: increasing and compelling epidemiological evidence

Curable Sexually Transmitted Infection Treatment Interventions to Prevent HIV Transmission in Sub-Saharan Africa

The Politics of Uncertainty: The AIDS Debate, Thabo Mbeki and the South African Government Response

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