title: Concentrated HIV subepidemics in generalized epidemic settings.
abstract: OBJECTIVE
  A relatively neglected topic to date has been the occurrence of concentrated epidemics within generalized epidemic settings and the potential role of targeted interventions in such settings. We review recent studies in high-risk groups as well as findings relating to geographical heterogeneity and the potential for targeting 'high-transmission zones' in the 10 countries with highest HIV prevalence.
  
  
  RESULTS
  Our review of recent studies confirmed earlier findings that, even in the context of generalized epidemics, MSM have a substantially higher prevalence than the general population. Estimates of prevalence of HIV among people who inject drugs (PWID) in sub-Saharan African countries are rarely available and, when they are, often outdated. We identified recent studies of sex workers in Kenya and Uganda. In all three cases - MSM, PWID, and sex workers - HIV prevalence estimates are mostly based on convenience. Moreover, good estimates of the total size of these populations are not available. Our review of recent studies of high-risk populations defined on the basis of geography showed high levels of both new and existing infections in Kenya (slums), South Africa (peri-urban communities), and Uganda (fishing villages).
  
  
  CONCLUSIONS
  Recent empirical findings combined with evidence from phylogenetic studies and supported by mathematical models provide a clear rationale for testing the feasibility, acceptability, and effectiveness of targeted HIV prevention approaches in hyperendemic populations to supplement measures aimed at the general population.
authors.affiliation: aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa bSchool of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa cSchool of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa dDepartment of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Tanser
authors.forename: Tulio
authors.initials: T
authors.lastname: de Oliveira
authors.forename: Mathieu
authors.initials: M
authors.lastname: Maheu-Giroux
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
mesh_terms: D058872:Epidemics / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D062486:Public Health Surveillance; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous