Correlation between National Peak HIV Prevalence and Concurrency, STI Treatment Capability, Condom Use and Circumcision: An Ecological Study

Background: The extent of the differential spread of HIV around the world remains incompletely explained. This paper examines the extent to which five explanatory variables (circumcision prevalence, condom usage, STI treatment coverage, number of sex partners, partner concurrency) are correlated with peak HIV prevalence rates at a country level. Methods: We performed linear regression analysis to measure the association between each of the independent variables and the national peak HIV prevalence rates for 15 - 49 years old. Results: Our analysis shows a strong positive association between peak HIV prevalence and the prevalence of partner concurrency (rho = 0.853;P = 0.001). There was no association between peak HIV prevalence and circumcision prevalence (rho = 0.118;P = 0.161), condom usage (rho = 0.048;P = 0.794), STI treatment coverage (rho = 0.143;P = 0.136) and number of sex partners (rho = 0.134;P = 0.298) at a global level. There was however a strong negative association between peak HIV prevalence and circumcision prevalence when the analysis was limited to countries within sub Saharan Africa (rho = -0.659;P = 0.000). Sub Saharan Africa had the second and third highest circumcision rates in the world when the circumcision prevalence thresholds were set at 80% and 20% respectively. Conclusions: Differences in the prevalence of circumcision likely influence differential peak HIV prevalence within sub Saharan Africa but are implausible causes for the higher HIV prevalence in this region. The close association found between concurrency and HIV prevalence requires replication in further studies.

The Prevalence of Syphilis Is Associated with the Prevalence of Male Point-Concurrency: An Ecological Analysis

Objective: The prevalence of syphilis differs considerably between different populations and indi-vidual level risk factors such as number of sex partners seem unable to completely explain these differences. The effect of network level factors, such as the prevalence of partner concurrency, on syphilis prevalence has not hitherto been investigated. Study design: Linear regression was per-formed to assess the relationship between the prevalence of male concurrency and prevalence of syphilis in each of 11 countries for which we could obtain comparable data. The data for concur-rency prevalence was taken from the WHO/Global Programme on AIDS (GPA) sexual behavioural surveys. Syphilis prevalence rates were obtained from antenatal syphilis serology surveys done in the same countries. In addition, we used linear regression to assess if there was a relationship between syphilis and concurrency prevalence of various racial and ethnic groups within the United States and South Africa. Results: In the international study, we found a strong relationship between the prevalence of male concurrency and syphilis prevalence (r = 0.79, P = 0.003). In the subnational studies, the relationship between concurrency and syphilis prevalence was positive in all cases but was only statistically significant so in the case of South Africa’s racial groups (r = 0.98, P = 0.01). Conclusions: The findings of an ecological-level association between syphilis and partner concurrency need to be replicated but suggest that efforts directed towards decreasing partner concurrency may reduce syphilis prevalence.

Hepatitis C virus among blood donors and general population in Middle East and North Africa:Meta-analyses and meta-regressions

BACKGROUND Despite the Middle East and North Africa(MENA)Region reported to have the highest prevalence of hepatitis C virus(HCV)globally,HCV infection levels in the majority of MENA countries remain inadequately characterized.Blood donor data have been previously used as a proxy to assess levels and trends of HCV in the general population,however,it is unclear how comparable these populations are in MENA and whether blood donors provide an appropriate proxy.AIM To delineate HCV epidemiology among blood donors and the general population in the MENA.METHODS The data source was the systematically gathered MENA HCV Epidemiology Synthesis Project Database.Random-effects meta-analyses and meta-regressions were conducted.For comparison,analyses were conducted for Europe,utilizing the Hepatitis C Prevalence Database of the European Centre for Disease Prevention and Control.RESULTS One thousand two hundred and thirteen HCV antibody prevalence measures and 84 viremic rate measures were analyzed for MENA.Three hundred and seventyseven antibody prevalence measures were analyzed for Europe.In MENA,pooled mean prevalence was 1.58%[95%confidence interval(CI):1.48%–1.69%]among blood donors and 4.49%(95%CI:4.10%–4.90%)in the general population.In Europe,pooled prevalence was 0.11%(95%CI:0.10%–0.13%)among blood donors and 1.59%(95%CI:1.25%–1.97%)in the general population.Prevalence in the general population was 1.72-fold(95%CI:1.50–1.97)higher than that in blood donors in MENA,but it was 15.10-fold(95%CI:11.48–19.86)higher in Europe.Prevalence was declining at a rate of 4%per year in both MENA and Europe[adjusted risk ratio:0.96(95%CI:0.95–0.97)in MENA and 0.96(95%CI:0.92–0.99)in Europe].Pooled mean viremic rate in MENA was 76.29%(95%CI:67.64%–84.02%)among blood donors and 65.73%(95%CI:61.03%–70.29%)in the general population.CONCLUSION Blood donor data provide a useful proxy for HCV infection in the wider population in MENA,but not Europe,and could improve HCV burden estimations and assess progress toward HCV elimination by 2030.

A Critical Appraisal of the Ideology of Monogamy’s Influence on HIV Epidemiology

The linked ideas that all members of society should only engage in monogamous relationships and that these should all be based on romantic love are decided outliers from a historical perspective. Despite this, there is a widespread contemporary belief that monogamy based on love is the most ethical and natural form of partnering for humans—mononormativism. It has long been accepted that our values influence how we frame and interpret scientific questions. In the article we ask, using the example of mononormativism, how does an individual’s sexual ethics influence how they pursue HIV epidemiology? Using a Social Intuitionalist theoretical framework, we argue that a belief in monogamy-as-normative has contributed to certain researchers dismissing the evidence that the generalized HIV epidemics in parts of Africa are due to higher rates of non-monogamy.