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

International Journal of STD & AIDS
David GisselquistStuart Brody

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 ...Continue Reading

Citations

Apr 22, 2010·International Journal of Epidemiology·Rebecca F BaggaleyMarie-Claude Boily
May 19, 2011·World Journal of Urology·John N Krieger
Jan 22, 2010·The Journal of Sexual Medicine·Stuart Brody
Jan 24, 2012·The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine·John J PotteratStuart Brody
Mar 12, 2015·Global Public Health·Robert S Van Howe
Aug 8, 2008·The Lancet Infectious Diseases·Kimberly A PowersMyron S Cohen
Jul 3, 2007·SAHARA J : Journal of Social Aspects of HIV/AIDS Research Alliance·David Gisselquist
Dec 1, 2011·Dialectical Anthropology·Samuel R Friedman, Diana Rossi
Nov 17, 2020·Euro-Mediterranean Journal for Environmental Integration·Samuel R Friedman

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