Drivers of STD/HIV epidemiology and the timing and targets of STD/HIV prevention

Russia and Eastern Europe have the fastest growing HIV epidemic in the world. As sexually transmitted infections (STIs) play an important role in HIV transmission, we conducted this study to find the prevalence of three microorganisms associated with STIs in Arkhangelsk Oblast, Russia. First void urine from 1729 participants was analysed using nucleic acid amplification testing, and all participants completed a questionnaire. One hundred and twelve (6.5%) were tested positive for Chlamydia trachomatis, 67 (3.9%) for Mycoplasma genitalium and 221 (12.8%) for Ureaplasma urealyticum. A significant association was found between C. trachomatis and U. urealyticum (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.1 to 3.0). U. urealyticum was associated with similar social demographics and sexual risks as C. trachomatis and M. genitalium. This suggests that U. urealyticum has a possible role as an STI pathogen or might be a contributing factor for the spread of other STIs.

show abstract

“…6,7,23,24 Our results confirm high prevalences of STI microorganisms in both clinical and non-clinical settings.…”

supporting

confidence: 90%

Chlamydia trachomatis,Mycoplasma genitaliumandUreaplasma urealyticumin clinical and non-clinical settings, Arkhangelsk Oblast, Russia

et al. 2012

View full text Add to dashboard Cite

show abstract

“…The risk of HIV and other STI acquisition through heterosexual transmission – the primary transmission pathway among FSWs, clients, and nonpaying partners – is determined by a complex interplay of individual biological, behavioural, and host genotypic and partner-level factors; namely, the average rate of partner contacts, probability of transmission (e.g., per unprotected sex act), and duration of infection [13,14]. …”

Section: Epidemiology Of Behavioural and Biological Factorsmentioning

confidence: 99%

HIV infection among female sex workers in concentrated and high prevalence epidemics

Shannon

Goldenberg

Deering

et al. 2014

Current Opinion in HIV and AIDS

155

149

View full text Add to dashboard Cite

Purpose of review This article reviews the current state of the epidemiological literature on female sex work and HIV from the past 18 months. We offer a conceptual framework for structural HIV determinants and sex work that unpacks intersecting structural, interpersonal, and individual biological and behavioural factors. Recent findings Our review suggests that despite the heavy HIV burden among female sex workers (FSWs) globally, data on the structural determinants shaping HIV transmission dynamics have only begun to emerge. Emerging research suggests that factors operating at macrostructural (e.g., migration, stigma, criminalized laws), community organization (e.g., empowerment) and work environment levels (e.g., violence, policing, access to condoms HIV testing, HAART) act dynamically with interpersonal (e.g., dyad factors, sexual networks) and individual biological and behavioural factors to confer risks or protections for HIV transmission in female sex work. Summary Future research should be guided by a Structural HIV Determinants Framework to better elucidate the complex and iterative effects of structural determinants with interpersonal and individual biological and behavioural factors on HIV transmission pathways among FSWs, and meet critical gaps in optimal access to HIV prevention, treatment, and care for FSWs globally.

show abstract

“…1 The differences in HIV prevalence between South Africa's racial/ethnic groups (19.9%, 3.2% and 0.5% for 15 -49-year-old blacks, coloureds and whites respectively 2 are as big as those between the highest-and lowest-prevalence countries in the world. These large racial/ethnic differences are not related to individual level risk factors such as lifetime number of sexual partners, but are more likely determined by different sexual network structures.…”

Section: 'Whereas Individual-level Parameters May Influence Which Indmentioning

confidence: 99%

Why have socioeconomic explanations been favoured over cultural ones in explaining the extensive spread of HIV in South Africa?

Kenyon

Colebunders

Dlamini

2012

South. Afr. j. HIV med.

View full text Add to dashboard Cite

Sexually transmitted infections (STIs) are transmitted via sexual networks, and differences in the structure of these networks constitute the key population-level parameter that determines differences in HIV prevalence. 1 The differences in HIV prevalence between South Africa's racial/ethnic groups (19.9%, 3.2% and 0.5% for 15 -49-year-old blacks, coloureds and whites respectively 2 are as big as those between the highest-and lowest-prevalence countries in the world. These large racial/ethnic differences are not related to individual level risk factors such as lifetime number of sexual partners, but are more likely determined by different sexual network structures.3 In African networks, sexual partnerships are more likely to be arranged concurrently, and this increases the interconnectedness of the sexual network in a non-linear fashion. Evidence from numerous sources and disciplines shows that these high concurrency rates are a key factor in driving high HIV transmission rates in southern and eastern Africa. Two main categories of factors have been advanced as being important in the promotion of these high concurrency rates: cultural and socio-economic factors. Socio-economic factors are unlikely to be the predominant determinants since neither HIV nor concurrency are contoured along the lines of poverty, at the level of countries or individuals. One of the few quantitative studies looking at the determinants of concurrency in South Africa found no relationship between income quintile and concurrency, but concurrency was more commonly practiced and accepted in black communities than among whites and coloureds. 5A literature review of the explanations for the striking differences in HIV spread by race in South Africa concluded that there was a strong bias favouring socio-economic explanations. 6 As an example, one of the premier textbooks on the epidemiology of HIV/AIDS in South Africa argues that the reason why HIV prevalence rates differ between races is that 'marginalisation and discrimination on the basis of race and/or ethnicity are key factors influencing vulnerability to HIV infection.' 7 No evidence however was provided to back up this assertion. What is the explication for this bias? We argue that the playing down of cultural factors in the South African HIV aetiological literature is the result of an intersection of three factors. EXPLAINING THE UNDER-APPRECIATION OF CULTURAL FACTORS HIV'S EmERGENCE IN A TImE OF THE RESONANCE AND CONSTRUCTION OF NON-RACIALISmThe first factor relates to the post-apartheid context of the emergence of HIV. Notions of white racial and cultural superiority were central pillars of the apartheid ideology. An uncritical use of race as an analytical variable and on occasion frankly racist views would characterise much South African medical and public health enquiry during the apartheid period. HIV then emerged into prominence during the difficult period while South Africa was attempting to build a new dispensation based on non-racialism. Given this backdrop and the fact that HI...

show abstract

Drivers of STD/HIV epidemiology and the timing and targets of STD/HIV prevention

Cited by 40 publications

References 17 publications

Chlamydia trachomatis,Mycoplasma genitaliumandUreaplasma urealyticumin clinical and non-clinical settings, Arkhangelsk Oblast, Russia

Chlamydia trachomatis,Mycoplasma genitaliumandUreaplasma urealyticumin clinical and non-clinical settings, Arkhangelsk Oblast, Russia

HIV infection among female sex workers in concentrated and high prevalence epidemics

Why have socioeconomic explanations been favoured over cultural ones in explaining the extensive spread of HIV in South Africa?

Contact Info

Product

Resources

About