title: HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission.
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.
authors.affiliation: Independent consultant, 29 West Governor Road, Hershey, Pennsylvania 17033, USA. david_gisselquist@yahoo.com
authors.forename: David
authors.initials: D
authors.lastname: Gisselquist
authors.forename: Richard
authors.initials: R
authors.lastname: Rothenberg
authors.forename: John
authors.initials: J
authors.lastname: Potterat
authors.forename: Ernest
authors.initials: E
authors.lastname: Drucker
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects; D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000635:transmission*; D017954:Africa South of the Sahara / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000009:adverse effects; D003906:Developing Countries; D004196:Disease Outbreaks; D004866:Equipment Contamination; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006679:HIV Seropositivity / Q000453:epidemiology; D020010:Heterosexuality; D006801:Humans; D015994:Incidence; D017757:Infectious Disease Transmission, Professional-to-Patient; D007267:Injections / Q000009:adverse effects; D016273:Occupational Exposure; D049590:Postpartum Period; D011295:Prenatal Care; D015995:Prevalence; D012307:Risk Factors