Factors Driving the HIV Epidemic in Southern Africa

McKinnon, Lyle R.; Karim, Quarraisha Abdool

doi:10.1007/s11904-016-0314-z

Cited by 36 publications

(29 citation statements)

References 146 publications

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“…We next assessed factors associated with different genital bacterial communities in our cohort, with particular attention to those that might increase HIV susceptibility (Byrne et al, 2016; McKinnon and Karim, 2016; Ward and Ronn, 2010) (Table S1). We observed no differences between bacterial communities and demographic factors, condom use, frequency or type of sexual acts, or number of sexual partners.…”

Section: Resultsmentioning

confidence: 99%

Lactobacillus-Deficient Cervicovaginal Bacterial Communities Are Associated with Increased HIV Acquisition in Young South African Women

et al. 2017

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Summary Elevated inflammation in the female genital tract is associated with increased HIV risk. Cervicovaginal bacteria modulate genital inflammation, however their role in HIV susceptibility has not been elucidated. In a prospective cohort of young, healthy South African women, we found that individuals with diverse genital bacterial communities dominated by anaerobes other than Gardnerella were at over 4-fold higher risk of acquiring HIV and had increased numbers of activated mucosal CD4+ T cells compared to those with Lactobacillus crispatus-dominant communities. We identified specific bacterial taxa linked with reduced (L. crispatus) or elevated (Prevotella, Sneathia, and other anaerobes) inflammation and HIV infection and found that high-risk bacteria increased numbers of activated genital CD4+ T cells in a murine model. Our results suggest that highly prevalent genital bacteria increase HIV risk by inducing mucosal HIV target cells. These findings may be leveraged to reduce HIV acquisition in women living in sub-Saharan Africa.

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Section: Resultsmentioning

confidence: 99%

Lactobacillus-Deficient Cervicovaginal Bacterial Communities Are Associated with Increased HIV Acquisition in Young South African Women

et al. 2017

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“…Young women (aged 15-24 years) bear a disproportionate burden of HIV infection, have an infection rate up to eight times higher than their male peers (Dellar, Dlamini, and Abdool Karim 2015), and acquire HIV infection at least five to seven years earlier than men (UNAIDS 2015). Several studies emphasise the biological (Dellar, Waxman, and Abdool Karim 2015;McKinnon and Abdool Karim 2016) and sociocultural complexities (Ackermann and Klerk 2002;Ogunlela 2014;Prince et al 2005;Weeks et al 2004) through which women negotiate safe-sex practices or condom use with their male partners. However, most available safer sex options require male co-operation.…”

Section: Introductionmentioning

confidence: 99%

Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa

Govender

Mansoor

MacQueen

et al. 2017

Culture, Health & Sexuality

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The release of World Health Organisation guidelines recommending the prophylactic use of daily Truvada ® for all populations at high risk of acquiring HIV opens the way for implementation of oral pre-exposure prophylaxis (PrEP). The impact of new prevention technologies is, however, dependent on demand creation strategies such as user awareness, acceptability and access, which in turn are influenced by sociocultural and gender norms. This study was conducted in three locations in KwaZulu-Natal, urban, rural and peri-urban, with six participatory workshops. Knowledge, desirable features of a product and demand positioning for PrEP were assessed using a participatory action media research process which included art-based activities and group discussion using a semi-structured interview schedule. The data were analysed using thematic analysis. The key themes that emerged in relation to product adoption were: ability to maintain secrecy of product use; the need for agency with personal choices around HIV prevention; and an increased desire for HIV protection. Findings reaffirm the influence of user engagement in understanding the sociocultural dynamics that influence demand creation for PrEP adoption.

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“…The greatest travel tends to be in rural areas, where poverty is high and there are very few employment opportunities. Results from recent empirical studies indicate that high levels of mobility could be a major driver of HIV transmission in generalized epidemics [4,5,[8][9][10]. Migrants and travelers in many SSA countries have been found to engage in riskier behaviors when they are away from home and are more likely to be infected with HIV than non-migrants/travelers.…”

Section: Introductionmentioning

confidence: 99%

Source-sink dynamics could sustain HIV epidemics in rural communities in sub-Saharan Africa: the case of Malawi

Okano

Sharp

Palk

et al. 2018

Preprint

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Background: Approximately 25.5 million individuals are infected with HIV in sub-Saharan Africa (SSA).Epidemics in this region are generalized, show substantial geographic variation in prevalence, and are driven by heterosexual transmission; populations are highly mobile. We propose that generalized HIV epidemics should be viewed as a series of micro-epidemics occurring in multiple connected communities. Using a mathematical model, we test the hypothesis that travel can sustain HIV micro-epidemics in communities where transmission is too low to be self-sustaining. We use Malawi as a case study. Methods:We first conduct a mapping exercise to visualize geographic variation in HIV prevalence and population-level mobility. We construct maps by spatially interpolating georeferenced HIV-testing and mobility data from a nationally representative population-level survey: the 2015-16 Malawi Demographic and Health Survey. To test our hypothesis, we construct a novel HIV epidemic model that includes three transmission pathways: resident-to-resident, visitor-caused and travel-related. The model consists of communities functioning as "sources" and "sinks". A community is a source if transmission is high enough to be self-sustaining, and a sink if it is not.Results: HIV prevalence ranges from zero to 27%. Mobility is high, 27% of the population took a trip lasting at least a month in the previous year. Prevalence is higher in urban centers than rural areas, but long-duration travel is higher in rural areas than urban centers. We show that a source-community can sustain a micro-epidemic in a sink-community, but only if specific epidemiological and demographic threshold conditions are met. The threshold depends upon the level of transmission in the source-and sink-communities, as well as the relative sizes of the two communities. The larger the source than the sink, the lower transmission in the source-community needs to be for sustainability. Discussion:Our results support our hypothesis, and suggest that it may be rather easy for large urban communities to sustain HIV micro-epidemics in small rural communities; this may be occurring in northern Malawi. Visitor-generated and travel-related transmission may also be sustaining micro-epidemics in rural communities in other SSA countries with highly-mobile populations. It is essential to consider mobility when developing HIV elimination strategies.

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Factors Driving the HIV Epidemic in Southern Africa

Cited by 36 publications

References 146 publications

Lactobacillus-Deficient Cervicovaginal Bacterial Communities Are Associated with Increased HIV Acquisition in Young South African Women

Lactobacillus-Deficient Cervicovaginal Bacterial Communities Are Associated with Increased HIV Acquisition in Young South African Women

Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa

Source-sink dynamics could sustain HIV epidemics in rural communities in sub-Saharan Africa: the case of Malawi

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