Concurrent sexual partnerships help to explain Africa's high HIV prevalence: implications for prevention

Abstract

As Kiat Ruxrungtham and colleagues describe in today's Lancet, HIV transmission in most Asian countries remains strongly associated with particularly high-risk activities—ie, injection-drug use, male-male sex, prostitution and, in China, paid donation of plasma. Although there is understandable concern that the virus could soon spread widely through the general population, 1 UNAIDS AIDS epidemic update 2003. Geneva: UNAIDS. http://www.unaids.org/Unaids/EN/Resources/Publications/corporate+publications/aids+epidemic+update+-+december+2003.asp Google Scholar , 2 Eberstadt N The future of AIDS. Foreign Affairs. Nov/Dec 2002; : 2-45 Google Scholar HIV has been present in Asia for nearly two decades and such extensive spread has yet to occur. For example, analysis of trends in India suggests that HIV prevalence, both in high-risk groups and in the generally low-risk antenatal clinic population, has probably stabilised in recent years. 3 World Health Organisation Joint tuberculosis programme review, India. WHO Regional Office for Southeast Asia, New DelhiSeptember 2003: 14 Google Scholar It is possible that large-scale heterosexual epidemics will never emerge in most of Asia, except perhaps on the island of Papua. 4 Chin J Bennett A Mills S Primary determinants of HIV prevalence in Asian Pacific countries. AIDS. 1998; 12: S87-S91 PubMed Google Scholar , 5 Cohen J Asia and Africa: on different trajectories?. Science. 2004; 304: 1932-1938 Crossref PubMed Scopus (24) Google Scholar , 6 Caldwell JC Isaac-Toua G AIDS in Papua New Guinea: situation in the Pacific. J Health Popul Nutr. 2002; 20: 104-111 PubMed Google Scholar Furthermore, in some of the world's most populated countries—Pakistan, Bangladesh, Indonesia, and the Philippines, home to some one billion people—nearly all men are circumcised, further restricting the potential for extensive heterosexual spread. 7 Short RV The HIV/AIDS pandemic: new ways of preventing infection in men. Reprod Fertil Devel. 2004; 16: 555-559 Crossref PubMed Scopus (16) Google Scholar , 8 Halperin D Bailey RC Male circumcision and HIV infection: ten years and counting. Lancet. 1999; 354: 1813-1815 Summary Full Text Full Text PDF PubMed Scopus (164) Google Scholar HIV/AIDS in AsiaHIV (ie, HIV-1) epidemics in Asia show great diversity, both in severity and timing. But epidemics in Asia are far from over and several countries including China, Indonesia, and Vietnam have growing epidemics. Several factors affect the rate and magnitude of growth of HIV prevalence, but two of the most important are the size of the sex worker population and the frequency with which commercial sex occurs. In view of the present state of knowledge, even countries with low prevalence of infection might still have epidemics affecting a small percentage of the population. Full-Text PDF HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differencesEvidence from surveillance of mostly urban antenatal clinic attendees indicates that the growth in the AIDS epidemic in sub-Saharan Africa has levelled off since the late 1990s but only eastern Africa shows a decline in HIV prevalence. Very large differences persist between subregions. Workers planning a response to the AIDS epidemic must take more careful consideration of these variations to allow locally appropriate responses to the epidemic. Full-Text PDF Social marketing of condoms is great, but we need more free condomsThe social-marketing condom campaign, The Three Amigos(figure), is a welcome advance in the effort to popularise condom use. On the basis of the success of other campaigns to advertise condoms,1,2 The Three Amigos campaign is likely to boost condom use. However, no matter how enthusiastically we advertise condoms, they cannot be used for protection if they are not available. The greatest obstacle to prevention of HIV transmission in many parts of the world is that there simply are not enough condoms around. Full-Text PDF