Is concurrency driving HIV transmission in sub-Saharan African sexual networks? The significance of sexual partnership typology.

Recently, there has been debate about the role of concurrent partnerships in driving the transmission of HIV, particularly in Southern Africa, where HIV prevalence is up to 25 % in many heterosexual populations and where evidence from sexual behavior surveys also suggests high levels of male concurrency. While mathematical modeling studies have shown that concurrency has the potential to enhance the speed at which HIV spreads in a population, empirical studies up to now have failed to provide conclusive evidence supportive of these effects. Here we discuss some reasons for the apparent discrepancy between theoretical and empirical studies.

Knowledge and perceptions of couples' voluntary counseling and testing in urban Rwanda and Zambia: a cross-sectional household survey.

Background: Most incident HIV infections in sub-Saharan Africa occur between cohabiting, discordant, heterosexual couples. Though couples' voluntary HIV counseling and testing (CVCT) is an effective, well-studied intervention in Africa, <1% of couples have been jointly tested.

Methods: We conducted cross-sectional household surveys in Kigali, Rwanda (n = 600) and Lusaka, Zambia (n = 603) to ascertain knowledge, perceptions, and barriers to use of CVCT.

AIDS in Asia amid competing priorities: a review of national responses to HIV.

Introduction: The paper reviews progress in addressing the HIV epidemic and questions whether at the midway mark to the conclusion of the Millennium Development Goal set for 2015, the goal number 6 of halting and reversing the HIV epidemic will be reached.

Methods: Fourteen 2008 United Nations General Assembly Special Session on HIV/AIDS country progress reports and 18 country reports on Universal Access 2009 were analyzed. Data on national HIV strategic plans was also provided by 18 countries that participated in the regional training on costed national strategic plans 15-16 September, in Bangkok in 2008.

Are we on course for reporting on the Millennium Development Goals in 2015?

Objectives: At the 2001 United Nations General Assembly Special Session on HIV/AIDS (UNGASS), Member States agreed to regularly review progress made in national responses to HIV. This article provides (1) a brief overview of how the resultant global UNGASS reporting system was developed; (2) the origins, background, limitations and potential of that system; (3) an overview of the articles in this supplement; and (4) crosscutting institutional and methodological issues.

Methods: United Nations Member States biennially provide The Joint United Nations Programme on HIV/AIDS (UNAIDS) with data on 25 core indicators of national responses to HIV, collected in Country Progress Reports.

Is there a gender gap in the HIV response? Evaluating national HIV responses from the United Nations General Assembly Special Session on HIV/AIDS country reports.

Background: The Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS), in 2001, sets out several policy and programmatic commitments that pertain to women and the gender aspects of the HIV epidemic. Some of them are general, whereas others are more specific and include time-bounded targets. This article summarizes data on policies and strategies affecting women and men equity in access to antiretroviral treatment and other HIV services, as reported by countries but do not address other issues of gender, such as men having sex with men.

Promotion of couples' voluntary counselling and testing for HIV through influential networks in two African capital cities.

Background: Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples' Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. We present our experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia.

How Uganda reversed its HIV epidemic.

Uganda is one of only two countries in the world that has successfully reversed the course of its HIV epidemic. There remains much controversy about how Uganda's HIV prevalence declined in the 1990s. This article describes the prevention programs and activities that were implemented in Uganda during critical years in its HIV epidemic, 1987 to 1994.

Epidemiology of HIV infection in urban Burkina Faso.

We conducted a cross-sectional study of sexually transmitted disease and HIV infections among a random sample of the 2364 adult population in 2000 in Bobo-Dioulasso, the second largest town in Burkina Faso. The prevalence of HIV infection was 5.2%.

Can highly active antiretroviral therapy reduce the spread of HIV?: A study in a township of South Africa.

Background: Calls have been made for the large-scale delivery of highly active antiretroviral therapy (HAART) to people infected with HIV in developing countries. If this is to be done, estimates of the number of people who currently require HAART in high HIV prevalence areas of sub-Saharan Africa are needed, and the impact of the widespread use of HAART on the transmission and, hence, spread of HIV must be assessed.

Objectives: To estimate the proportion of people eligible for combination antiretroviral therapy and to evaluate the potential impact of providing HAART on the spread of HIV-1 under World Health Organization (WHO) guidelines in a South African township with a high prevalence of HIV-1.

Does increased general schooling protect against HIV infection? A study in four African cities.

Background: The association between educational attainment and risk of HIV infection varies between populations and over time. Earlier studies in sub-Saharan Africa have found that those with more education are at increased risk of HIV infection.

Methods: We investigated the associations between general schooling and both HIV and herpes simplex-2 (HSV-2) infection using data from the multicentre study on factors determining the differential spread of HIV in four African cities.

Changing patterns of knowledge, reported behaviour and sexually transmitted infections in a South African gold mining community.

Background: In 1998, a major HIV intervention project was started in a mining community in Carletonville, South Africa. This included community-based peer education, condom distribution, syndromic management of sexually transmitted infections (STI), and presumptive STI treatment for sex workers.

Objectives: To investigate changes in sexual behaviour and the prevalence of STI before and 2 years after the start of the HIV prevention programme.

HIV risk in relation to marriage in areas with high prevalence of HIV infection.

In sub-Saharan Africa, the prevalence of HIV infection among young women is much higher than that among young men. Many women enter marriage HIV-infected, suggesting that men may be predominantly infected by their wives. Using data from cross-sectional surveys in Kisumu, Kenya, and Ndola, Zambia, in 1997, the prevalence of HIV infection at marriage was estimated from age at marriage and age- and sex-specific prevalence of HIV infection among unmarried individuals.

Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe.

Background: HIV-1 prevalence typically rises more rapidly at young ages in women than in men in sub-Saharan Africa. Greater susceptibility to infection on exposure in women is believed to be a contributory factor as is greater exposure to previously infected sexual partners of the opposite sex. We investigated the latter hypothesis using data from a field study in rural Manicaland, Zimbabwe.

Study of bias in antenatal clinic HIV-1 surveillance data in a high contraceptive prevalence population in sub-Saharan Africa.

Objective: To describe patterns, sources and consequences of bias in antenatal clinic (ANC) HIV prevalence estimates in a high contraceptive prevalence population.

Background: HIV surveillance in Africa relies on data from pregnant women attending ANCs. HIV estimates from pregnant women understate female infection levels in low income, high fertility populations.

Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, Côte d'Ivoire, 1991-1998.

Objective: To assess clinic- and community-based trends in demographic and behavioral characteristics and clinic-based trends in HIV infection and other sexually transmitted diseases (STD) in female sex workers in Abidjan, Côte d'Ivoire.

Design: Multiyear cross-sectional study of first-time attenders in Clinique de Confiance, a confidential STD clinic; biannual community-based behavioral surveys.

Methods: From 1992 to 1998, female sex workers were invited to attend Clinique de Confiance, where they were counseled, interviewed, clinically examined during their first visit and tested for STD and HIV infection.