Publication on HIV infection among youths in South Africa
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High prevalence of HIV infection among youth in a South African min-
ing town is associated with HSV-2 seropositivity and sexual behaviour
Bertran Auvert, Ron Ballard, Catherine Campbell, Michel Cara�l, Mat-
thieu Carton, Glenda Fehler, Eleanor Gouws, Catherine MacPhail, Dirk
Taljaard, Johannes Van Dam, Brian Williams
Contact:
Dr B. Auvert
INSERM U88, 14 Rue du Val d'Osne
94415 Saint-Maurice
Cedex, France
Tel: +33-1-4518-3871
Fax: +33-1-4518-3889
mailto:bertran.auvert@paris-ouest.univ-paris5.fr
AIDS Volume 15, number 7
AIDSONLINE Press release
http://www.aidsonline.com/
This paper will be for a short period freely available on-line on
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In this study published in AIDS, the authors found an extremely high
prevalence of HIV among young women (34%) and men (9%) aged 14-24
years from a township in the Carletonville district of South Africa.
HIV prevalence among women aged 24 was 66%, one of the highest rates
ever reported in a general population. The authors suggest that these
remarkable findings are due to high rates of HIV transmission from
men to women, and the major role played by HSV-2 (herpes simplex vi-
rus type 2) in the spread of HIV in this population.
South Africa is experiencing one of the most rapidly growing HIV epi-
demics in the world. In 1990 the prevalence of HIV infection among
women attending antenatal clinics was less than 1%. By the end of
1999 national prevalence had reached 23%. Most of the studies that
have been performed in sub-Saharan Africa to date have investigated
risk factors for HIV infection among adults, but young people, and
especially young women, are at particularly high risk of HIV infec-
tion in many developing countries.
The authors claim that the high prevalence of HIV infection among
young women compared to young men in the Carletonville study is not
simply due to either very high rates of infection amongst their part-
ners or to very high levels of sexual activity. In fact, in almost
all surveys carried out across Eastern and Southern Africa by the
World Health Organization, men report a higher turnover of partners
before marriage than women, and in this study the mean number of
partners was 4.7 for men and 2.6 for women.
One reason for this discrepancy in HIV prevalence between young men
and young women is that HIV is more easily transmitted from men to
women than from women to men. Studies in industrialized countries
have shown that, in the absence of other risk factors, men are two to
three times more likely to transmit HIV to women than vice versa.
However, the estimates of transmissibility of HIV from men to women
in the Carletonville study are significantly higher than this, even
taking into account the possibility of women under-reporting their
number of sexual partners. There are several possible explanations
for this. A recent study has shown that viral load is an important
predictor in the risk of heterosexual HIV transmission, and viral
loads are likely to be higher in South Africa than in Europe or the
US due to the reduced availability of effective drugs and treatment.
Another factor may be the high prevalence of HSV-2 (herpes simplex
virus type 2) in this population, as HSV-2 can facilitate HIV infec-
tion.
In the Carletonville study HSV-2 status was the most significant fac-
tor associated with HIV status for both men and women. For example,
men infected with HSV-2 were seven times more likely to also be HIV
positive than those who did not have HSV-2. HSV-2 acts as a co-factor
in HIV transmission by causing genital ulcers which both increase the
susceptibility of the uninfected to infection by HIV, and increase
the infectivity of those who already carry the virus.
Reducing HIV transmission in this population is a major challenge. At
the present time genital herpes can only be treated at considerable
cost, and no vaccine is currently available. Therefore the best op-
tions for reducing transmission include communication campaigns aimed
at alerting the population to the relatively mild manifestation of
genital herpes and the need to abstain from sexual contact while le-
sions persist. In addition it is important to find ways to persuade
young people to reduce their number of sexual partners and, most im-
portantly of all, to substantially increase condom use; in this
study, 41% of men and 42.5% of women reported never having used con-
doms. As most young people in this study were still at school when
they had their first sexual experience, attempts to limit the future
spread of HIV should involve not only prevention in the community but
also effective school-based interventions as an essential part of the
school curriculum.
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