International Journal of STD & AIDS > Volume 13, Number 10 > Pp. 657-666

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Editorial Review

HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission

David Gisselquist, Richard Rothenberg, John Potterat and Ernest Drucker

Independent consultant, 29 West Governor Road, Hershey, Pennsylvania 17033, USA; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia; Independent consultant; Department of Epidemiology and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, NYC, USA

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.

Key Words: IATROGENIC • NOSOCOMIAL • HIV • AIDS • SUB-SAHARAN AFRICA

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