other facilitating factors (cofactors) for epidemic spread
 
  • sexual practices

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  • dry sex
  • condom use - but note many women/men don't want contraception
  • physiological and genetic cofactors

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    newly considered possibility: health-care acquired infection (Gisselquist et al.)
     

    1) Africans have approx. 1 unsafe injection (unsterilized/reused equipment) per year on average

    2) Africans who have     received injections more likely to be HIV-positive (could be due to treatment for HIV, though)

    3) infants and children who are HIV-positive but have uninfected mothers

    4) health-care acquired infections in low risk groups across world (e.g., Romanian orphans, Russian kids, plasma donors in China, etc.)


    other reasons why heterosexual epidemic unlikely in North America/ Europe
     
     

  • new infections decreased as a result of safer injection/sex practices; infected dying off

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  • infections will remain concentrated among those who continue risky behaviors (anal sex, sharing injection paraphernalia), remain more densely connected (gay/bi men, drug injectors), and already have higher prevalence of infection

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    Sample of effective social/behavioral interventions
     
     

  • partner notification

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  • needle exchange (syringe exchange)

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  • condom distribution in high risk venues

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  • also effective in reducing HIV risk: methadone maintenance treatment for opiate injectors

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