Factors associated with HIV prevalence in a pre-partum cohort of Zambian women

Abstract

An ongoing study of mother-to-child human herpes virus-8 (HHV-8) transmission in Zambian women (n = 3160) allowed us to examine the association of medical injections with HIV serostatus while simultaneously accounting for other factors known to be correlated with HIV prevalence. Multi-method data collection included structured interviews, medical record abstraction, clinical examinations, and biological measures. Medically administered intramuscular or intravenous injections in the past five years (but not blood transfusions) were overwhelmingly correlated with HIV prevalence, exceeding the contribution of sexual behaviours in a multivariable logistic regression. Statistically significant associations with HIV also were found for some demographic variables, sexual behaviours, alcohol use, and sexually transmitted diseases (STD). The results confirmed that iatrogenic needle exposure, sexual behaviour, demographic factors, substance use, and STD history are all implicated in Zambian women's HIV+ status. However, the disproportionate association of medical injection history with HIV highlights the need to investigate further and prospectively the role of health-care injection in sub-Saharan Africa's HIV epidemic.

Overestimation of heterosexually attributed AIDS deaths is associated with immature psychological defence mechanisms and clitoral masturbation during penile–vaginal intercourse

“…6 However, anal sex, both homosexual and heterosexual (the latter often in a male bisexual context), in sub-Saharan Africa is rather common, 4 and blood exposures (notably from unsafe health care) alone might account for the preponderance of non-vertical HIV infections. 1,5,8,10 When unsafe health care is adequately measured in African research studies, traditional sexually transmitted disease risk factors (non-use of condoms, number of sexual partners, PVI frequency) have generally been found to be unrelated to incident HIV infection. 5,8,10 Most importantly, by avoiding the vagaries of risk-factor epidemiology and directly examining tissue susceptibility, it has been demonstrated experimentally that massive quantities of HIV applied to vaginal and cervical tissue (without leakage at the edge of the samples or using preparation methods producing excessive tissue damage) are unable to cause infection, but the same experimental conditions readily infect rectal tissue.…”

“…1,5,8,10 When unsafe health care is adequately measured in African research studies, traditional sexually transmitted disease risk factors (non-use of condoms, number of sexual partners, PVI frequency) have generally been found to be unrelated to incident HIV infection. 5,8,10 Most importantly, by avoiding the vagaries of risk-factor epidemiology and directly examining tissue susceptibility, it has been demonstrated experimentally that massive quantities of HIV applied to vaginal and cervical tissue (without leakage at the edge of the samples or using preparation methods producing excessive tissue damage) are unable to cause infection, but the same experimental conditions readily infect rectal tissue. 14 -16 The risk of a reasonably healthy adult contracting HIV infection through PVI is not only miniscule on an absolute basis, but also relative to the other willingly assumed mortal risks of everyday life.…”

Perspective on Providing Partner Notification Services for HIV in Sub-Saharan Africa

“…6 Of particular concern to the Zimbabwean researchers is the possibility that observed heterogeneity in HIV prevalence in heterosexuals could be explained by unsafe medical practices, such as the reuse of needles and other sharps, echoing similar conclusions from previous reports. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] As is well known, in poor countries, opportunities for unsanitary medical, dental, ritualistic, or cosmetic procedures abound 27,28 as do, consequently, opportunities for the effective transmission of blood-borne agents such as hepatitis viruses and HIV. Both historically and presently, most investigations into the HIV epidemics in sub-Saharan Africa have (surprisingly) focused almost exclusively on sexual intercourse variables and related risk markers.…”

Sexual Behavior, HIV and South African Youth

“…Behavioral campaigns have been responsible for the dramatic declines in HIV incidence in Uganda [9]; in both Uganda and Zimbabwe, reductions in partner concurrency were instrumental in bringing down HIV incidence [9,10].…”