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HIV/sexually transmitted infection epidemiology, management and control in the IUSTI Africa region: focus on sub-Saharan Africa
  1. David A Lewis1,2,3,4
  1. 1Sexually Transmitted Infections Reference Centre, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
  2. 2Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  3. 3Division of Microbiology, University of Cape Town, Cape Town, South Africa
  4. 4London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Professor David A Lewis, STI Reference Centre, National Institute for Communicable Diseases, National Health Laboratory Service, Private Bag X4, Sandringham 2131, South Africa; davidl{at}nicd.ac.za

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Introduction

Sexually transmitted infections (STI), including those caused by HIV types 1 and 2, remain a major public health problem in Africa, causing death through AIDS, cervical cancer, congenital syphilis and ectopic pregnancy, as well as significant morbidity in terms of HIV-related illness, disseminated syphilitic infection and multiple reproductive tract sequelae. Published estimates, available from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the WHO, indicate that Africa remains the continent worst affected by HIV/STI.1 2

HIV/AIDS epidemiology, management and control

According to UNAIDS 2009 estimates, sub-Saharan Africa accounted for 68% of global HIV infections, 68% of new adult HIV infections, 92% of new infections in children and 72% of all AIDS-related deaths.1 In the same year, regional estimates suggest that more than 14.1 million children have lost one or both parents to AIDS. The HIV/AIDS epidemic continues to have a disproportionate impact on women and girls in sub-Saharan Africa, with women aged 15–24 years being eight times more likely to be infected with HIV than their male counterparts.1 National household surveys report that HIV affects individuals from all socioeconomic groups and that HIV prevalence is generally higher in urban compared with rural areas.3

As with all generalised HIV/AIDS epidemics, heterosexual transmission is the primary mode of HIV transmission in the region and female commercial sex workers (CSW) remain a key population for HIV prevention efforts. Within Africa, the potential importance of men who have sex with men (MSM), in terms of enhanced HIV transmission among MSM sexual networks and ‘bridging’ into heterosexual sexual networks, is only now being recognised and MSM research remains in its infancy.4 Although the prevalence of injecting drug users is relatively low in Africa, it is estimated that one in eight injecting drug users are infected with HIV.5 The proportion of infants infected with HIV …

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