Sexual Risk Factors for HIV Infection in Early and Advanced HIV Epidemics in Sub-Saharan Africa: Systematic Overview of 68 Epidemiological Studies
Chen, L., Jha, P., Stirling, B., et al. PLoS ONE (2007), 2(10), pp. e1001.
Multiple partners, paid sex, and sexually transmitted infections (STIs) are considered risk factors for HIV infection at the early stages of the HIV epidemic when HIV is concentrated among high-risk groups. These risk groups are assumed to be less important once the epidemic has spread into the general “low risk” population. The study authors used 68 epidemiological studies from 18 countries in sub-Saharan Africa from 1986 to 2006 to test this common assumption. The general trends over time indicate that these risk factors are also strong predictors of HIV infection in high-prevalence settings, where epidemics were considered generalized. Contrary to common wisdom, multiple partners, paid sex, and STI infection remain important risk factors in countries with high HIV prevalence. The authors recommend reexamination the UNAIDS definition of a “generalized” epidemic and the recommendation that STI treatment in countries with advanced epidemics is likely to have a low impact. This analysis indicates that prevention efforts should focus on vulnerable groups, regardless of where the trajectory of the HIV epidemic lies.