Title: Running on empty: sexual co-factors are insufficient to fuel Africa's turbocharged HIV epidemic.

POPLINE Document Number: 194638

Author(s):

Gisselquist D
Potterat JJ
Brody S

Source citation:

International Journal of STD and AIDS, 2004 Jul;15(7):442-452.

Abstract:

The hypothesis that heterosexual transmission drives sub-Saharan Africa’s HIV epidemics requires much faster transmission dynamics in Africa than in the US and Europe, where heterosexual transmission is arguably insufficient to maintain existing levels of HIV prevalence. Initially, experts surmised that Africans had more sexual partners; however, studies of sexual behaviour circa 1990 undermined this assumption. Next, it was supposed that the high burden of bacterial sexually transmitted disease (STD) in Africa explained greater HIV transmission efficiency; however, during the 1990s, community studies in Africa showed that STD had much less than expected impact on HIV transmission. Current attempts to explain HIV as a primarily sexual epidemic in Africa propose multiple factors, including herpes simplex virus type 2, lack of male circumcision, concurrency, and others. These factors also fail for various reasons to account for Africa’s HIV epidemics: they are present also in the US and/or Europe; they do not correlate with differences in HIV prevalence across Africa; etc. While behavioural and biological variables influence personal risk for HIV acquisition, the available evidence suggests that they do not differentiate African from US and European epidemics, nor do they determine the differential HIV epidemic trajectories noted across Africa. (author's)

Keywords:

Africa, Sub Saharan
Critique
Evaluation
Heterosexuals
Multiple Partners
HIV Positive Persons
HIV Infections
Prevalence
Sex Behavior
Risk Behavior
Risk Factors
Genetics
Herpes Genitalis
Bacterial and Fungal Diseases
Male Circumcision
Africa
Developing Countries
Behavior
Sexual Partners
Viral Diseases
Diseases
Measurement
Research Methodology
Biology
Sexually Transmitted Diseases
Reproductive Tract Infections
Infections