We Haven’t Checked, But We Conclude HIV is All About Sex in Africa

1 Mar

In an article entitled ‘Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data‘, Dr Steve Bellan et al aimed to estimate “the proportional contribution of different routes of transmission to new HIV infections”, in the light of plans to give antiretroviral drugs to as many people as possible.

Using data on 27,201 cohabiting couples from 18 countries in sub-Saharan Africa, the researchers “estimated the proportion of recorded infections in surveyed cohabiting couples that occurred before couple formation, between couple members, and because of extra-couple intercourse.” In conclusion, they estimated that “extra-couple transmission accounted for 27—61% of all HIV infections in men and 21—51% of all those in women, with ranges showing intercountry variation.” They also estimated that in 2011 “extra-couple transmission accounted for 32—65% of new incident HIV infections in men in cohabiting couples, and 10—47% of new infections in women in such couples.” They write: “Our findings suggest that transmission within couples occurs largely from men to women; however, the latter sex have a very high-risk period before couple formation.”

They interpret their findings as follows: “Because of the large contribution of extra-couple transmission to new HIV infections, interventions for HIV prevention should target the general sexually active population and not only serodiscordant couples.”

This will greatly please those who wish to get as many people as possible on antiretroviral drugs. The ‘general sexually active population’ are to be targeted by HIV interventions that include the administration of expensive drugs with serious side effects and need to be taken every day for the rest of people’s lives. How many people will be ‘targeted’ with this kind of antiretroviral drug regime? It could be tens, even hundreds of millions of people, compared to fewer than 10 million people currently on antiretroviral drugs globally.

If you think the authors’ conclusions raise a lot of important questions that they don’t discuss in their paper, there’s something else they have left out. They have no idea how many of those 27,201 people may have been infected with HIV through some non-sexual mode of transmission, such as unsafe healthcare, unsafe cosmetic or unsafe traditional practices. They appear to have concluded that because they are all sexually active, everyone one of them must have been infected with HIV through sexual contact.

The authors themselves say “As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is crucial to target intervention efforts.” I quite agree. But they don’t seem to have explored any non-sexual routes of transmission. Will no effort be made to reduce non-sexually transmitted HIV? So much for peer-reviewed research.

For more about non-sexually transmitted HIV through unsafe healthcare, cosmetic and traditional practices, see the Don’t Get Stuck With HIV site.

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