AIDS in Third World countries [letter]
The high incidence of acquired immunodeficiency syndrome (AIDS) in heterosexual men in Haiti and Central Africa has been hypothesized to result from the widespread prevalence of sexually transmitted diseases in these areas. Such infections cause breaks in the skin of the penis, creating an entry point for the AIDS virus during intercourse in which there is contact with infected vaginal secretions. The author rejects this explanation. In the case of Central Africa, unsterile injection equipment and infected blood products are significant modes of transmission. The author further conjectures that, because most men in Haiti and Central Africa are not circumcised, they constantly develop balanitis, leading to breakage of the skin. This leads to chronic infections such as phimosis and paraphimosis. In such conditions, there is often ulceration of the foreskin of the penis, representing a potential portal of entry for the AIDS virus during intercourse with an infected prostitute. There is also the possibility of mini-ulcerations occurring during intercourse as the foreskin comes into contact with public hair. These factors seem to be more plausible explanations for the female to male transmission of AIDS in Central Africa and Haiti than concomitant sexually transmitted diseases.