From 2002 until 2005 a male circumcision (MC) trial was conducted in Orange Farm. The trial showed a protective effect of MC of about 60%. Following this trial there was an ethical obligation of the funder to offer this effective treatment to the entire community. This project, which was named the Bophelo Pele Male Circumcision Read More
In November 2009 the Flemish Research Fund and the Flemish Interuniversity Council approved two proposals concerning “Data-driven modelling of the impact of wide-scale, early HIV treatment on the incidence of HIV in South Africa”. Both projects will be launched in 2010 and involve research and capacity building components as well as efforts to intensify the Read More
An article published in the June 2009 edition of the SACEMA Quarterly reported on the positive association between genital herpes (most often caused by Herpes Simplex Virus type 2 (HSV-2)) and HIV acquisition (1). It has been argued that HSV-2 could have a major role in fuelling the spread of HIV and that significant numbers Read More
The central theme of this first SACEMA Quarterly Epidemiological Update of 2010 is the rate of occurrence of new HIV infections – also known as HIV incidence. The issue is examined through three distinct perspectives: 1) Recent advances in measuring the HIV incidence in a population, and/or how it changes over time, 2) estimating the relative importance of various ‘modes of transmission’ in contributing to new cases of HIV infection, and 3) the use of antiretroviral treatment of infected individuals to curb their infectivity and hence reduce HIV incidence.
Prevalence and incidence are the two most important indicators of the state of an epidemic. The most common way in which incidence is measured is by follow-up of an initially uninfected cohort. For infections with a relatively short duration, another method for estimating incidence is available using a cross-sectional survey. Unfortunately, HIV has a long asymptomatic phase before the onset of immune failure and AIDS. In this article a way to estimate HIV incidence using biomarkers in cross-sectional surveys is described and the challenges of this approach are discussed.
Behaviour change interventions have not brought about a sufficient reduction in HIV transmission. The question is whether anti-retroviral therapy (ART), used to effectively treat HIV patients, could also be used to stop transmission. This article discusses whether treatment-as-prevention is feasible, by determining the extent to which ART reduces the infectiousness of HIV-positive people. Furthermore, it looks at whether this is a realistic approach, by considering the levels of acceptance and compliance that might be achieved, the cost of the drugs, the rate of development of resistance, drug delivery and patient management.
Effective planning and delivery of HIV prevention programs depends on an understanding of where new infections are occurring and on the behaviours associated with those infections. A simple mathematical model developed by the UNAIDS Reference Group for Estimates, Modelling and Projections helps countries estimate the proportion of new infections that occur through key transmission modes. This type of in-country analysis could be used to inform the planning of appropriately targeted intervention programmes. However, improved biological and behavioural surveillance in countries is needed to provide more reliable data for input into such analyses.