What proportion of HIV infections are attributable to genital ulcers in sub-Saharan Africa?

Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.

What proportion of HIV infections are attributable to genital ulcers in sub-Saharan Africa?

Int Conf AIDS. 1992 Jul 19-24;8(1):Mo10 (abstract no. MoC 0029). Unique Identifier : AIDSLINE ICA8/92399990
Hayes RJ; Schulz KF; London School of Hygiene and Tropical Medicine, UK.

Abstract: OBJECTIVES: The heterosexual transmission of HIV is assumed to be facilitated in the presence of other STDs, but the strength of this effect, and the proportion of HIV infections in sub-Saharan Africa attributable to the presence of STDs, are unknown. This study considers problems in the estimation of this cofactor effect, and uses data from previously reported studies to produce rough estimates of (i) the per-exposure effect of genital ulceration (GUD), and (ii) the fraction (PAF) of HIV infections in African populations which may be attributable to GUD. METHODS: Data from a longitudinal study of prostitutes in Nairobi were used to estimate the cofactor effect of GUD on male-to-female transmission per HIV exposure, by allowing for the number of exposures. The cofactor effect on female-to-male transmission was estimated from a longitudinal study in Nairobi of males following a single prostitute contact. Likely values of the PAF were estimated for a population with a current adult HIV prevalence of about 10% using a range of plausible assumptions about the frequency of GUD and of HIV-exposure. RESULTS: The data are compatible with a relative risk of transmission per HIV-exposure of about 20-40 for male-to-female transmission, and of about 100-2000 for female-to-male transmission, in the presence of GUD. Rough estimates of the PAF were around 20% for prostitutes, and 75-98% for males and 20-40% for females in the general population. CONCLUSIONS: These estimates rest on a number of assumptions, and should be interpreted cautiously. The wide range in the estimates reflects uncertainties in (i) the size of the cofactor effect, especially for female-to-male transmission, and (ii) the frequency and pattern of occurrence of GUD and HIV-exposure in the general population. However, they suggest that STD control might have a substantial effect on the spread of the epidemic.

Keywords: Africa/EPIDEMIOLOGY Female Follow-Up Studies Genital Diseases, Female/*COMPLICATIONS/EPIDEMIOLOGY Genital Diseases, Male/*COMPLICATIONS/EPIDEMIOLOGY Human HIV Infections/*EPIDEMIOLOGY/TRANSMISSION Kenya/EPIDEMIOLOGY Male Prevalence Prostitution Risk Risk Factors Ulcer/*COMPLICATIONS/EPIDEMIOLOGY ABSTRACT
921230
M92C5357

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