Responding to the HIV epidemic through estimating the modes of HIV transmission: a multi-country analysis
E. Gouws, For the Multi-country Collaboration on Estimating Modes of HIV Transmission
UNAIDS, Epidemiology and Analysis Division, Geneva, Switzerland
Background: Understanding the distribution of new HIV infections by mode of transmission is essential for adequately targeting prevention programs. Here we analyse results from several countries involved in efforts to “know your epidemic, know your response”.
Methods: A model was developed by UNAIDS to help countries estimate the proportion of new infections that occur through key transmission modes including sex work, injecting drug use (IDU), men having sex with men (MSM), multiple partnerships, stable relationships, and medical interventions. Countries in Southern, East and West Africa as well as in Latin America and the Caribbean have conducted this analysis. Modelling results are compared within and between regions and are used to make general recommendations for targeting HIV prevention programs. The contribution to country specific prevention efforts and resource allocation is also assessed.
Results: Estimates of the distribution of new HIV infections by modes of transmission are available for Benin, Burkina Faso, Côte d'Ivoire, Dominican Republic, Ghana, Kenya, Lesotho, Mozambique, Nigeria, Peru, Senegal, Swaziland, Uganda, Zambia. In southern and East Africa the majority of new infections occur in the general heterosexual population, either among discordant couples or as a result of having multiple partners, with greater variation in East Africa. In West Africa, sex work, IDU and MSM together account for about one quarter of all new infections. In Peru, the largest proportion of new infections occur among MSM.
Conclusions: Results from sub-Saharan Africa suggest that prevention efforts need to focus on reducing the risk of multiple partnerships, expanding testing programs to identify discordant couples, and increasing or maintaining high levels of condom use with casual and commercial partners. Programming for groups with high risk behaviour is needed across countries with different prevalence levels. All countries showed an urgent need for improved data to better understand and respond to specific risk behaviours.
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