Rewriting the narrative of the epidemiology of HIV in sub-Saharan Africa
OUTPUT TYPE: Journal Article
PUBLICATION YEAR: 2012
TITLE AUTHOR(S): S.Baral, N.Phaswana-Mafuya
KEYWORDS: AFRICA, DRUG USE, EPIDEMIOLOGY, HIV/AIDS, HOMOSEXUALITY, MEN, RISK BEHAVIOUR, SEXUAL BEHAVIOUR
DEPARTMENT: Public Health, Societies and Belonging (HSC)
Print: HSRC Library: shelf number 7467
HANDLE: 20.500.11910/3215
URI: http://hdl.handle.net/20.500.11910/3215
If you would like to obtain a copy of this Research Output, please contact Hanlie Baudin at researchoutputs@hsrc.ac.za.
Abstract
The fight against HIV remains complicated with contracting donor resources and high burden of HIV among reproductive age adults still often limiting independent economic development. In the widespread HIV epidemics of sub-Saharan Africa (SSA), it is proposed that key populations with specific HIV acquisition and transmission risk factors, such as men who have sex with men (MSM), female sex workers (FSW), and people who use drugs (PUD), are less relevant because HIV transmission is sustained in the general population with average HIV acquisition and transmission risks. However, the understanding that key populations are less relevant in the epidemics of Africa is based on the surveillance system from which these populations are mostly excluded. Outside of SSA, the epidemics of HIV are generally concentrated in the same populations that are excluded from the primary HIV surveillance systems in SSA. The manuscripts included in this special issue present convincing data that FSW, MSM, and PUD carry disproportionate burdens of HIV wherever studied in SSA, are underrepresented in HIV programs and research, and require specific HIV prevention services. These manuscripts collectively suggest that the only effective path forward is one that transcends denial and stigma and focuses on systematically collecting data on all populations at risk for HIV. In addition, there is a need to move to a third generation of HIV surveillance as the current one inadvertently devalues HIV surveillance among key populations in the context of widespread HIV epidemics. Overall, the data reviewed here demonstrate that the dynamics of HIV in Africa are complex and achieving an AIDS-free generation necessitates acceptance of that complexity in all HIV surveillance, research, and prevention, treatment, and care programs.-
Related Research Outputs:
- Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa
- HIV testing and self-reported HIV status in South African men who have sex with men: results from a community-based survey
- Methodological and ethical challenges in conducting behavioural and HIV surveillance among men who have sex with men (MSM) in South Africa
- Researching MSM in South Africa: some preliminary notes from the frontlines of a hidden epidemic
- The Johannesburg/eThewkini Men's Study (JEMS): a rapid assessment of the HIV epidemic among men who have sex with men (MSM) in South Africa: technical report
- Stigma and discrimination experiences of HIV positive men who have sex with men (MSM) and heterosexual men in Cape Town, South Africa
- The fallacy of intimacy: sexual risk behaviour and beliefs about trust and condom use among men who have sex with men in South Africa
- HIV prevalence and risk practices among men who have sex with men in two South African cities
- You became afraid to tell them that you are gay: health service utilization by men who have sex with men in South African cities
- Attitudes towards condom use may explain why older black South African msm engage in unprotected insertive anal sex more frequently
- Sexual violence and HIV risk among black men who have sex with men in South African townships
- Communicating HIV status in sexual interactions: assessing social cognitive constructs, situational factors, and individual characteristics among South African MSM
- After-nine, 429, he-she, stabane, and gay, bisexual and other 'men sleeping with men': diversity in black South African MSM identities and implications for HIV prevention
- "Gays have money": the gendered nature and meanings of transactional sex among black men who have sex with men in South Africa
- Layered stigma and HIV/AIDS: experiences of men who have sex with men (MSM) in South Africa
- Integrated strategies for combination HIV prevention: principles and examples for men who have sex with men in the Americas and heterosexual African populations
- Age and sexual risk among black men who have sex with men in South Africa: the mediating role of attitudes towards condoms
- Lessons learnt in a HIV behavioural survey using respondent driven sampling (RDS) among men who have sex with men (MSM) in three South African cities
- Social networks, social support and HIV-risk behaviors among men who have sex with men in Durban, South Africa: a pilot study
- Exploring repeat HIV testing among men who have sex with men in Cape Town and Port Elizabeth, South Africa