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SOUTHERN AFRICA: "Lethal cocktail" to blame for HIV - study
IRIN News
August 14, 2006

http://www.irinnews.org/report.asp?ReportID=55114

JOHANNESBURG - A "lethal cocktail" of low condom use by people with multiple sexual partners, combined with low levels of male circumcision, are the key factors driving soaring rates of HIV/AIDS in Southern Africa, the epicentre of the global epidemic, according to a study released on Monday.

Casting doubt on long-held beliefs about how the disease spreads in countries such as South Africa, Swaziland and Botswana, the report by the Southern African Development Community (SADC) said high-risk activities such as casual sex and intercourse with sex workers were no longer the principal causes of new infections.

Instead, individuals with many concurrent sexual relationships, without consistently using condoms, were fuelling the spread of the virus, while traditional high-risk groups such as prostitutes, mineworkers and truckdrivers were, in fact, better protecting themselves from infection.

The report found that in Uganda, Kenya, and Zimbabwe - countries where the incidence of new HIV infections has recently slowed - the essential factor behind successfully controlling the spread of the disease was a reduction in the number of sexual partners an individual had at the same time.

"Without knowing it, if many individuals [or their partners] have only one additional longer-term sexual partner, huge numbers of people may be at risk of HIV infection if only one person in the sexual network is newly infected. This is in part because in the few weeks after infection [the window period], the infected person is much more likely to transmit HIV to his/her sexual partners," the report said.

The SADC found that abstinence - long touted as the best and easiest way to slow the spread of HIV - was not a panacea. It suggested a new 'DRC' (Delay sex, Reduce partners, continue Condom use) approach to tackling HIV, as a refinement of the old 'ABC' (Abstinence, Be faithful, Condoms) model.

"While a focus on abstinence may result in delays in young people starting sex, this does not have a large impact on their lifetime risk of HIV infection once they start being sexually active, if they engage in multiple partnerships, etc," the report said.

The study also commented that "voluntary counselling and testing (VCT) has not been shown to date to have as strong an impact on behaviour change as previously hoped. Counselling and testing is still very important, however, as an entry point for care and treatment".

According to the SADC, the HIV prevalence rate among those aged 15-49 in Southern Africa is 11 percent, compared to only 1 percent globally. Approximately 40 percent of the world's HIV-positive people were in the region, which was also the source of 37 percent of all new infections in 2005.

The stubbornly high numbers worry anti-AIDS campaigners, many of whom denounce Southern African governments for doing too little, too late to stop the spread of the virus. The number of adults living with HIV in South Africa - the continent's richest country - was estimated at 5.3 million in 2003 - or about one in five of those aged 15-49.

The SADC report pointed to underlying social and structural factors, such as high population mobility, disparity of wealth, cultural factors and gender inequality, which put young women particularly at risk, were driving the rapid spread of the disease across the region.

It recommended male circumcision as one important method of controlling the spread of HIV, citing a recent study that found the procedure had a 60 percent to 75 percent preventative effect on potential HIV transmissions. Evidence shows that the cells of the inner surface of the foreskin are particularly susceptible to infection.

"Male circumcision on its own is not enough to prevent HIV infection, and circumcised males must still use condoms and reduce their number of partners," the SADC said. "However, if a large number of males become circumcised, this could significantly reduce new HIV infections in the population as a whole."

Nevertheless, it urged caution on the efficacy of circumcision, saying more research was necessary.

The SADC, based in Botswana, was founded in 1980 to coordinate development projects to lessen economic dependence on then-apartheid South Africa.

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