HIV prevention programmes in Africa that target couples that have one infected partner are not doing enough to bring about a reduction in the virus among the general population, experts warn today.
Instead, the focus should be on the larger sexually active population, a report in The Lancet claims.
Dr Steve Bellan, of the University of Texas, Austin, USA, said the problem arose because of the numbers of extra-marital relationships that cause the spread of the virus.
“Because of the large contribution of extra-couple transmission (from outside partnerships) to new HIV infections, interventions should target the larger sexually active population and not just serodiscordant couples [which describes one partner being HIV-positive and the other not having the infection],” he said.
“Pre-couple (prior to relationship), extra-couple, and within-couple transmission are all common, and HIV control policies that address all these routes are needed to stem the HIV epidemic in Africa.”
This new study developed a sophisticated modelling system that, unlike previous models, combines serostatus and relationship data from demographic and health surveys (DHS) with country-specific trends for HIV, as well as survival times.
They used the model to distinguish the specific ways that individuals became infected in 27,201 cohabiting couples from 18 sub-Saharan African countries.
It is believed that 30% of all new HIV infections in men and 10% in women within stable partnerships are the result of sex outside marriage.
Meanwhile, another study by Epicentre and Institut de Recherche pour le Développement (IRD) researchers has shown that men are less responsive to antiretroviral therapy treatment for AIDS than women.
Looking at 13,000 patients who were monitored through four programmes carried out by Médecins sans frontières (France) in Malawi, Uganda and Kenya, it was found that the reconstitution of lymphocyte cells, called T-CD4, is slower in men than in women.
The authors suggested that awareness-raising initiatives should be carried out among all populations to encourage screening and treatment as soon as possible.
Bellan S, Fiorella K et al. Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data. The Lancet. 5 February 2013; doi: org.10.1016/S0140-6736(12)61960-6 [abstract]
Leave a Reply