Intimate partner violence (IPV) is a worldwide epidemic. Physical and sexual violence are the most well-studied forms of IPV from an epidemiological point of view. Both of these have serious implications for other aspects of physical and mental health. In particular, women who have experienced IPV are more likely to be HIV-positive. In a modelling study we investigated some closely related questions about HIV and IPV in South Africa.
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 most recent South African National HIV Prevalence, Incidence and Behaviour Survey conducted in 2012 incorporated new tools for generating greater information about the current state of the HIV epidemic from the national household survey. The results from the direct HIV incidence estimates from the multi-assay recent infection algorithm from the survey and estimates from more conventional modelling approaches to estimating incidence were found to generate fairly similar results. The 2012 household survey data also provided an opportunity to externally validate model projections over time.
According to the President’s Emergency Plan for AIDS Relief (PEPFAR), an AIDS-free generation entails that first, no one will be born with the virus; second, that as people get older, they will be at a far lower risk of becoming infected than they are today; and third, that if they do acquire HIV, they will get treatment that keeps them healthy and prevents them from transmitting the virus to others. We argue that an AIDS-free generation is possible in Southern Africa, but not unless the high rates of incident infections in key populations are reduced.
SACEMA has been very active in refining the use of laboratory tests for identifying recent infection (in particular of HIV) for the purpose of estimating disease incidence. We have just published a conceptual analysis of the notion of ‘test optimisation’ in a surveillance context, which should help clarify some persistent confusion that has hindered discourse in this area for years.
Using a catalytic model no significant reduction of HIV incidence was found despite increasing ART coverage.
Household surveys estimate the proportion of HIV infected persons in KwaZulu-Natal at a level of ~23% of the population. What is urgently needed is to seek ways to reduce HIV incidence while caring for existing infections in KZN. The emerging course of action against HIV spread is to use a combination of prevention interventions rather than relying on individual tools. This article discusses mathematical modelling conducted to forecast the impact of combined interventions at both the short- and long-term. The modelling shows the importance of repeated high coverage of testing, linkage to care, starting treatment on time (at CD4 count 350 or less), and high coverage of circumcision in order to reduce the rate of HIV infection in KZN.
One question repeatedly arises at meetings in which HIV risk and prevention are discussed: should health authorities be concerned by factors that increase the per-sex-act risk of HIV infection by 2-3 fold? The rationale by some health practitioners is that the risk of acquiring HIV infection is low, in the region of 0.04% and 1.7% Read More
The central theme of this SACEMA Quarterly is the HIV/TB co-epidemic. From 1-4 June 2010 the 2nd TB conference was held in Durban, in which most of the presentations discussed TB in relation to HIV. A SACEMA affiliate presented a study concluding that intensified HIV testing and early initiation of antiretroviral therapy (ART) for women and men aged 25-40 would optimise the cost-effectiveness of applying the test-and-treat strategy in South Africa, as this would have the largest impact on TB as well. One of the main articles in this Quarterly discusses whether ART will help, and to what extend, in lowering TB incidence. Other articles focus on meaningful statistical modelling in public health, and the Zibambele programme (job creation and poverty alleviation) and it’s role in the battle against HIV/AIDS and TB. Finally, the new director of SACEMA is announced: Dr. Alex Welte.
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