dry sex

condom use - but note many women/men don't want contraception

• lack of male circumcision

• STD infection

• poor health/nutrition/immunity/health care systems

• genetic vulnerability

• smallpox virus and HIV have one type of attack in common when they infect cells

• 20% of Europeans have inherited immunity to smallpox and HIV - evolved response to centuries of smallpox epidemics; smallpox new to Africa

• therefore, Africans less likely to be immune

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

• evidence to suggest this might be a factor:

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.)

• how could health-care acquired infection appear like sexual transmission?

• highly sexually active persons most at risk for STD and pregnancy

• both conditions often lead to health care (injections for STD treatment, many kinds of invasive contact for pregnancy/birth), which could result in HIV transmission

• infants and children possibly infected as a result of routine health care (vaccinations, etc.)

other reasons why heterosexual epidemic unlikely in North America/ Europe
 
 

• AIDS implosion and lack of a major heterosexual HIV epidemic in the U.S. foretold by Potterat in 1987

Sample of effective social/behavioral interventions
 
 

• process:

• public health workers interview infected persons to elicit their sexual/injection partners

• workers and/or patients locate partners, refer them to testing/counseling, treatment as appropriate

• confidential

• benefits

• "… takes you right where the problem is" (R. Rothenberg)

• i.e., persons who have been exposed to infected individuals by risky contact

• for STDs, treatment of infected partners stops further transmission from those persons

• prevention efforts focused on those most likely to be infected or become infected - not watered down on a broad scale campaign

• identify sexual and injection networks that sustain an epidemic

• geographic aspects, network structure, which risky behaviors involved

• where (geographically and socially) to focus other prevention resources

• for HIV, treatment more effective when begun earlier; treatment reduces infectiousness

• process

• drug injectors turn in used needles and get as many new, sterile ones in return

• principle

• reduce need for having to reuse own or someone else's syringe

• benefits

• associated with reduced HIV, HBV, HCV prevalence

• communities that began needle exchange early in the epidemic  have had much lower rates of HIV among drug injectors than communities that began needle exchange later

• exchangers somewhat less likely to become infected than nonexchangers

• exchangers' level of needle sharing generally less than that of nonexchangers

• doesn't change amount or frequency of drug use/injection

• fewer discarded needles on streets, playgrounds, etc.

• Managua, Nicaragua

• prostitution and non-commercial encounters in motels

• Egger et al. (2000) - randomized experiment to evaluate different approaches for increasing condom use

• make condoms freely available in motel rooms

• put in motel rooms prevention brochures that urged safer sex

• on each separate day of study, randomly assigned each of set of motels to one or both conditions (no condoms/brochures, condoms or brochures only, condoms + brochures)

• providing condoms in the rooms increased condom use by 30-80%

• prevention brochures had no or slight negative effect on condom use