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Reprinted from International Journal of STD and AIDS, 2002 October
13(10):657-66
HIV in Sub-Saharan Africa Not Explained by Sexual Transmission
By Gisselquist D, Rothenberg R, Potterat J, Drucker E.
“An expanding body of evidence challenges the conventional
hypothesis that sexual transmission is responsible for more than
90% of adult HIV infections in Africa.”
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ABSTRACT
An expanding body of evidence challenges the conventional hypothesis
that sexual transmission is responsible for more than 90% of adult
HIV infections in Africa. Differences in epidemic trajectories across
Africa do not correspond to differences in sexual behaviour. Studies
among African couples find low rates of heterosexual transmission,
as in developed countries. Many studies report HIV infections in
African adults with no sexual exposure to HIV and in children with
HIV-negative mothers. Unexplained high rates of HIV incidence have
been observed in African women during antenatal and postpartum periods.
Many studies show 20%-40% of HIV infections in African adults associated
with injections (though direction of causation is unknown). These
and other findings that challenge the conventional hypothesis point
to the possibility that HIV transmission through unsafe medical
care may be an important factor in Africa's HIV epidemic. More research
is warranted to clarify risks for HIV transmission through health
care.
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