Using trends in the rate of new HIV infections in east and southern Africa we assess the current state of the epidemic and evaluate the future prospects for controlling it. If we let an incidence of 1 per 1,000 people represent a control threshold then this has been reached, or will probably be reached by 2020, in East Africa and is reachable by 2020 in those southern African countries that do not have strong social and economic ties to South Africa, if they continue to scale up their treatment programmes. South Africa, Lesotho, Mozambique and Swaziland could reach the control threshold by 2030 with sufficient political will and commitment to ‘treatment for all’.
The far-reaching, highly ambitious Sustainable Development Goals (SDGs) build upon the momentum generated by the Millennium Development Goals (MDGs) and are intended as a guide for health, social and economic initiatives until 2030. Implemented correctly, the STI agenda may well fit better within the SDGs than the MDGs, although that does not become directly clear at first glance. For refocusing attention on the control of STIs in the forthcoming years we propose a framework, most especially within low- and middle-income countries (LMICs).
Evidence that age-disparate relationships (ADR) between young women and older men are an important route of transmission of HIV infection is limited. The results from recent studies indicate that heterosexual relationships between young women and older men may help sustain the epidemic within some populations of South Africa and Malawi. However, the way in which age differences serve to sustain the epidemic of HIV may be different than what has been previously described in observational studies. This article proposes several public health intervention recommendations in relation to ADR and the epidemic of HIV.
Planet Earth has been here for over 4.5 billion years, but in just two human generations we have managed to place our only “home” at great risk. Given today’s uncertainties – social, economic, geopolitical, and environmental, it is clear that many lessons from history have not yet been learned and new lessons may prove equally, if not more, difficult to take on board as we head deeper into this century. My new book seeks to raise awareness about major global issues we face, stimulate discussion or debate and find ways forward to ensure planet and people sustainability.
There have been numerous papers and books on South Africa’s catastrophic era of AIDS denialism. There is much less known and written about the “when-to-start antiretrovirals (ARVs)” debate. This debate offers a fascinating look at how scientific disagreements between reasonable people, who are experts in the field, work, and how consensus evolves as evidence accumulates.
HIV and human papillomavirus (HPV) are two heavy hitting sexually transmitted infections (STIs). Meta-analyses of the association between HPV prevalence and HIV acquisition and the association between HIV prevalence and new HPV detection have estimated a two-fold increased risk in both directions, after adjusting for individual-level (sexual behavioural) factors. The studies argue that biological mechanisms may be responsible for these increased risks, but they also concur that residual confounding due to behaviour at the sexual network level cannot be ruled out. We used an individual based model to shed some light on the matter.
Emerging, zoonotic, and vector-borne diseases are often lumped together in a seemingly hodge-podge “other” category of infectious diseases. Although the pathogens causing these diseases are different, factors that they have in common are discussed here. In this issue of the Quarterly, you will find articles that represent a diverse array of scientific perspectives from around the world, bringing a wide range of epidemiological approaches to bear on emerging, zoonotic, and vector-borne diseases.
Rabies has until very recently been very much a neglected disease, with thousands of deaths occurring every year in low- and middle-income countries. But recent in-country prioritization exercises have highlighted that rabies is a priority for countries like Kenya. By modelling the different tools that can be applied to help us to reach the target to eliminate human deaths from dog-mediated rabies by the year 2030.What this shows us for now is that we need to use both human and animal vaccines more effectively to deliver on this possibility.
Forecasting when and where Ebola outbreaks will occur is difficult, especially because the ‘reservoir hosts’ of the viruses that cause this disease are not known for certain. There has been a focus on modelling Ebola disease in people and this has informed epidemic control strategies. Less attention has been given to modelling the initial ‘spillover’ events from other species to people, or disease dynamics in reservoirs, because of a lack of data. However, because the wildlife reservoirs and mechanism of spillover are poorly understood, modelling approaches can be used to identify or exclude hypotheses even when data are limited.
From the onset of an infectious disease outbreak, there is a need for public health guidance. In order to inform this guidance, one needs to understand the potential risks that are associated with the outbreak. At this stage, however, large scale studies providing robust evidence for Zika virus are lacking, and evidence only slowly accumulates as the outbreak expands. This article discusses approaches to two challenges that the Zika virus outbreak presented: 1) Establishing causality between Zika virus and adverse neurological outcomes in the absence of high quality epidemiological studies; 2) Establishing the risk of sexual transmission in the presence of multiple transmission routes.