Dissident AIDS Database

EpidemiologySexual transmissionHeterosexual intercourseAfrica
Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda
 Gray Ronald H, Wawer Maria J, Brookmeyer Ron, Sewankambo Nelson K, Serwadda David, Wabwire-Mangen Fred, Lutalo Tom, Li Xianbin, vanCott Thomas, Quinn Thomas C, and the Rakai Project
  “174 monogamous couples, in which one partner was HIV-1 positive, were retrospectively identified from a population cohort in Rakai, Uganda . . . The mean frequency of intercourse was 8,9 per month, which declined with age and HIV-1 viral load. Members of couples reported similar frequencies of intercourse. The overall unadjusted probability of HIV-1 transmission per coital act was 0·0011 (95% CI 0·0008-0·0015)...The probability of transmission per act from HIV-1-positive women to their HIV-1-negative male partners was 0.0013, compared with a transmission probability of 0.0009 per act from HIV-1-positive men to HIV-1-negative women... The probability of HIV transmission per sex act in Uganda is comparable to that in other populations, suggesting that infectivity of HIV subtypes cannot explain the explosive epidemic in Africa”
  Lancet Volume, 14 april 2001, 357, Pages 1149 to 11532001
Virus Hunters of the CDC
 McCormick Joseph B. and Fisher-Hoch Susan
  As proof that these "AIDS symptoms" were sexually transmitted, McCormick and Fisher-Hoch relied on a narrow survey conducted by Kevin DeCock, another CDC epidemiologist. DeCock examined stored blood samples taken in 1976 (for Ebola virus testing) from 600 residents of the small town of Yambuku, in northern Zaire. Samples from five patients (0.8%) tested positive for HIV antibodies... DeCock further noted that antibody tests conducted in 1986 showed that the HIV prevalence in Yambuku had remained constant at 0.8% during the ten years since 1976... DeCock did not consider that these same data could have been interpreted as indicating that HIV is a mild virus, and difficult to transmit. Neither did McCormick and Fisher-Hoch.
  Atlanta: Turner Publishing, 1996, pp. 188-90.1996
Update on Uganda : an analysis of the predictions and assumptions about the former epicenter of the AIDS epidemic. Implications for other African countries
 Fiala Chistian
  "Results of the latest antenatal screening survey in South Africa do not support the hypothesis of HIV being transmitted and confirm other publications. This survey includes testing of pregnant women for HIV and syphilis. One would expect a correlation of both diseases in geographical distribution and any change over time. Surprisingly this is not the case – on the contrary. KwaZulu-Natal, which is leading when it comes to HIV, has the lowest rate of syphilis of all provinces. Western Cape on the other hand had the highest rate of syphilis in 2000 but the lowest HIV prevalence. Northern Cape had the highest rate in syphilis in 2001 but the third lowest HIV in that year. Apparently there is an inverse geographical correlation between these two diseases although both are said to be transmitted by the same mode: heterosexual intercourse. (national hiv and syphilis sero-prevalence survey of women attening public antenatal clinics in SA, 2001, ministry of health, Pretoria)"
  http://bmj.bmjjournals.com/cgi/eletters/327/7408/184-a2003
Late seroconversion in HIV-resistant Nairobi prostitutes despite pre-existing HIV-specific CD8+ responses
 Kaul R, Rowland-Jones SL, Kimani J, Dong T, Yang HB, Kiama P, Rostron T, Njagi E, Bwayo JJ, MacDonald KS, McMichael AJ, Plummer FA
  "Eleven prostitutes meeting criteria for HIV resistance seroconverted between 1996 and 1999... Immunologic and behavioral variables were compared between late seroconverters and persistently uninfected sex worker controls...The key epidemiologic correlate of late seroconversion was a reduction in sex work over the preceding year."
  J Clin Invest 2001 Feb;107(3):341-92001
NATIONAL HIV AND SYPHILIS SERO-PREVALENCE SURVEY IN SOUTH AFRICA (Summary Report)
 Makubalo LE, Netshidzivhani PM, Mulumba R, Levin J, du Plessis H, Ratsaka M, et al.
  The survey included testing pregnant women for syphilis and antibodies to HIV in order to see how the two diseases were correlated by geographical location and over time. But, there was no correlation. On the contrary, KwaZulu-Natal, which is leading when it comes to HIV, has the lowest rate of syphilis in all provinces (see figure). No correlation between syphilis & HIV prevalence among antenatal attendees in South African Provinces. KwaZulu-Natal (KZN), Mpumalanga (MP), Gauteng (GP), Free State (FS), North West (NW), Eastern Cape (EC), Limpopo province (LP), Northern Cape (NC), Western Cape (WC).Western Cape, on the other hand, had the highest rate of syphilis in 2000 but the lowest HIV prevalence. Northern Cape had the highest rate of syphilis in 2001 but the third lowest prevalence of HIV antibodies in that year. Paradoxically, then, there is an inverse geographical correlation between syphilis and HIV although both are said to be transmitted by heterosexual intercourse. An even more extraordinary result is the divergence over time between an increasing prevalence of antibodies to HIV and a declining rate of syphilis. This is also difficult to understand given the assumption that both are sexually transmitted.
  Pretoria, South Africa: Directorate: Health Systems Research, Research Coordination and Epidemiology, 20012001
Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomized community trial.
 Wawer MJ, et al.
  The intention of the study had been to reduce HIV incidence by mass treatment of STDs with conventional antibiotics. The rationale behind the study was that reducing STDs (which was assumed to be a co-factor in the transmission of HIV) should reduce the transmission of HIV. However, the result of the study was paradoxical. While the investigators were very successful in significantly reducing STDs, their intervention had “no [effect] on incidence of HIV-1 infection... .”
  Lancet 1999; 353: 525-535.1999
Mounting anomalies in the epidemiology of HIV in Africa: cry the beloved paradigm.
 Brewer DD et al.
  “There is substantial dissonance between much of the epidemiologic evidence and the current orthodoxy that nearly all of the HIV burden in sub-Saharan Africa can be accounted for by heterosexual transmission and the sexual behaviour of Africans. The mounting toll of HIV infection in Africa is paralleled by a mounting number of anomalies in the many studies seeking to account for it. We propose that existing data can no longer be reconciled with the received wisdom about the exceptional role of sex in the African AIDS epidemic…Yaounde (in Cameroon, a nation with low and stable prevalence) had the highest level of risky behavioural markers. Ndola (in Zambia, a nation that has experienced a rapid rise in HIV) had the smallest proportion of both men and women who reported a non-spousal sex partner in the previous 12 months. Ndola’s other markers were similar to those in Dakar, Senegal and Cotonou, Benin, other areas with low, stable prevalence…We are aware of no study from sub-Saharan Africa suggesting cyclic sexual network architecture. Without evidence of appropriate network configurations on a scale considerably larger than that observed in developed countries, rapid propagation of HIV in Africa would be difficult to sustain…”
  Int J STD AIDS. 2003;14:144-7.2003
Evidence of iatrogenic HIV transmission in children in South Africa
 Brody Stuart, Gisselquist David, Potterat John J., Druckerb Ernest
  For example, in a large survey of women in South Africa, only 1.6% reported having been raped before age 15 (Jewkes R, Levin J, Mbananga N, Bradshaw D. Rape of girls in South Africa. Lancet 2002;359:319–320), and despite extensive media coverage of infected men seeking virgin girls as a `cure' for their HIV infection, few cases have been documented (Jewkes R, Martin L, Penn-Kekana L. The virgin cleansing myth: cases of child rape are not exotic. Lancet 2002;359:711). In another South African investigation, the rate of HIV seroconversion following child rape was 1% only, which, along with previous reports, argues against high transmission efficiency even under such circumstances (Lindegren ML, Hanson IC, Hammett TA, Beil J, Fleming PL, Ward JW. Sexual abuse of children: intersection with the HIV epidemic. Pediatrics 1998;102:E46, van As AB, Withers M, Du Toit N, Millar AJW, Rode H. Child rape—patterns of injury, management and outcome. S Afr Med J 2001;91:1035–1038) ...Only 1.4% of 12–14 year olds in the HSRC sample reported being sexually experienced, a rate lower than in other surveys of similarly aged South Africans (Eaton L, Flisher AJ, Aaro LE. Unsafe sexual behaviour in South African youth. Soc Sci Med 2003;56:149–165). Rates of partner accumulation and of sexual activity among sexually experienced youth respondents were also modest. Even assuming substantial under-reporting of sexual behaviours, the preponderance of HIV infections in children in the South African HSRC sample remains unexplained.
  BRITISH JOURNAL OF OBSTETRICS & GYNAECOLOGY, Volume 110: Pages 450-452, May 2003.2003
Heterosexual transmission of HIV in Haiti.
 Deschamps MM, Pape JW, Hafner A, Johnson WD Jr.
  Despite the importance of human immunodeficiency virus (HIV) transmission through heterosexual contact, the incidence of HIV infection in heterosexual cohorts has not been well studied, particularly in the developing world. To 1) determine the incidence of HIV infection in discordant heterosexual couples (couples in which one partner had HIV infection and the other did not) in Haiti and 2) assess risk factors for and methods of preventing HIV infection. Prospective study. National Institute for Laboratory Research, Portau-Prince, Haiti. 475 HIV-infected patients and their noninfected regular sex partners. Patients and their partners were evaluated at 3- to 6-month intervals for HIV infection, sexually transmitted diseases, and sexual practices. The efficacy of counseling and provision of free condoms was also evaluated. Among the 177 couples who remained sexually active during the prospective study period, 20 seroconversions to HIV positivity occurred, for an incidence rate of 5.4 per 100 person-years (95% CI, 5.16 to 5.64 per 100 person-years). Thirty-eight couples (21.5%) discontinued sexual activity during the study. Only 1 seroconversion occurred among the 42 sexually active couples (23.7% of the 177 sexually active couples) who always used condoms. In contrast, the incidence in sexually active couples who infrequently used or did not use condoms was 6.8 per 100 person-years (CI, 6.49 to 7.14 per 100 person-years). Transmission of HIV was associated with genital ulcer disease, syphilis, and vaginal or penile discharge in the HIV-negative partner and with syphilis in the HIV-infected partner. Counseling and the provision of free condoms contributed to the institution of safe sex practices or abstinence in 45% of discordant heterosexual couples. However, 55% of couples reported that they continued to have unprotected sex, resulting in an incidence of HIV infection of 6.8 per 100 person-years.
  Ann Intern Med. 1996;125:324-3301996
Heterosexual transmission of HIV-1 among employees and their spouses at two large business in Zaire.
 Ryder RW, Ndilu M, Hassig SE.
  “In 85% of these infected couples, only one member was HIV-1 seropositive despite repeated unprotected sex...”
  AIDS 1990; 4: 725-732.1990
Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial.
 Kamali A et al.
  “Compared with group C [routine health services], the incidence rate ratio of HIV-1 was 0·94 in group A [behavioural interventions against STDs] and 1·00 in group B [behavioural interventions and STI treatment], and the prevalence ratio of use of condoms with last casual partner was 1·12 in group A and 1·27 in group B. Incidence of…active syphilis…and prevalence of gonorrhoea were both lower in group B than in group C [i.e. the interventions had no significant effect on rates of HIV positivity, even though they did reduce rates of sexually transmitted diseases, and did encourage use of condoms] ”
  Lancet. 2003 Feb 22;361(9358).2003
The multicentre study on factors determining the differential spread of HIV in four African cities: summary and conclusions.
 Buve A, Carael M, Hayes RJ, et al.
  A large study of sexual risk factors for HIV infection in four African cities—two with high and two with low prevalence—found that rate of partner change, sex with prostitutes, concurrent partnerships and lack of condom use were not more common in high prevalence cities. The authors concluded that sampling bias, shifts in sexual behaviour over time or misreporting by respondents did not explain their observations (Buve A, Lagarde E, Carael M, et al. Interpreting sexual behaviour data: validity issues in the multicentre study on factors determining the differential spread of HIV in four African cities. AIDS 2001;15(Suppl 4): S117–S126).
  AIDS 2001;15(Suppl 4):S127 – S131.2001
The myth of heterosexual AIDS: how a tragedy has been distorted by the media and partisan politics.
 Fumento M.
  These and other anomalies led Brewer et al. to “propose that existing data can no longer be reconciled with the received wisdom about the exceptional role of sex in the African epidemic.”
  Washington, DC: Regnery Gateway, 19901990
Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa.
 Lagarde E, Auvert B, Carael M, et al.
  A large study of sexual risk factors for HIV infection in four African cities—two with high and two with low prevalence—found that rate of partner change, sex with prostitutes, concurrent partnerships and lack of condom use were not more common in high prevalence cities. The authors concluded that sampling bias, shifts in sexual behaviour over time or misreporting by respondents did not explain their observations (Buve A, Lagarde E, Carael M, et al. Interpreting sexual behaviour data: validity issues in the multicentre study on factors determining the differential spread of HIV in four African cities. AIDS 2001;15(Suppl 4): S117–S126).
  AIDS 2001;15:877 – 884.2001
HIV epidemicity in context of STI declines: a telling discordance.
 Potterat JJ, Brody S.
  Discordance between rapid HIV transmission levels in the context of decreasing sexually transmitted disease diagnoses and increasing condom use, in Zimbabwe
  Sex Transm Infect 2002;78:467.2002
HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission.
 Gisselquist D, Rothenberg R, Potterat J, Drucker EM.
  "An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behavior. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. By the end of the 1980s, a consensus emerged among AIDS experts dealing with Africa that over 90% of adult HIV infections in sub-Saharan Africa were acquired through heterosexual contact and less than 2% through unsafe injections. Unfortunately, this consensus was achieved without research to address confound between sexual and medical exposures”. In serodiscordant couples in Africa the "rate of transmission [of antibodies to HIV] per coital act [is] only 0.0011, comparable to rates of 0.0003-0.0015 from similar studies in the US and Europe."
  Int J STD AIDS 2002;13:657–666.2002
Evidence of iatrogenic HIV transmission in children in South Africa
 Brody Stuart, Gisselquist David, Potterat John J., Druckerb Ernest
  The common belief that 90% of HIV transmission in Africa is driven by heterosexual exposure is no longer tenable. Evidence supporting a much larger role for parenteral HIV transmission in medical settings in Africa has recently been painstakingly detailed
  BRITISH JOURNAL OF OBSTETRICS & GYNAECOLOGY, Volume 110: Pages 450-452, May 2003.2003
Let it be sexual: how health care transmission of AIDS in Africa was ignored.
 Gisselquist D, Potterat JJ, Brody S, Vachon F
  The common belief that 90% of HIV transmission in Africa is driven by heterosexual exposure is no longer tenable. Evidence supporting a much larger role for parenteral HIV transmission in medical settings in Africa has recently been painstakingly detailed
  Int J STD AIDS 2003;14:148–161.2003