16 August 2006
Multiple concurrent partnerships in which consistent condom use tends to be low, combined with low levels of male circumcision, are the key drivers of HIV/Aids in southern Africa.
This is according to a report released on Monday following a meeting of experts convened by the Southern African Development Community (SADC). The meeting was attended by prominent researchers, members of national Aids bodies, and representatives the United Nations and various NGOs and international donors.
The report forms part of a series of activities being undertaken by the SADC, in partnership with regional partners and the international community, to highlight issues around HIV prevention.
According to the report, significant contributing drivers of HIV/Aids in southern Africa were: male attitudes and behaviours, intergenerational sex, gender and sexual violence, stigma, lack of openness, untreated viral sexually transmitted infections, and lack of consistent condom use in long-term multiple and concurrent partnerships.
“These drivers are worsened by underlying social and structural factors such as high population mobility, inequalities of wealth, cultural factors and gender inequality that render young women particularly at risk of HIV infection, in addition to their greater biological vulnerability,” the report noted.
It is estimated that approximately 40% of all people living with HIV globally are in the SADC sub-region, and that approximately 37% of all new infections in 2005 occurred in this sub-region.
Longer-term multiple relationships
The report said that in the high-prevalence countries of mainland southern Africa, high-risk sexual activities – such as casual sex, sex with commercial sex workers and other individuals at high risk of HIV infection – were no longer the main drivers of the epidemic in terms of numbers of new infections.
It said HIV transmission was more likely to occur within longer-term multiple concurrent sexual partnerships, as people were less likely to consistently use condoms within these more regular relationships.
The experts also reviewed the evidence from a recently concluded randomised controlled trial on male circumcision in Orange Farm in South Africa’s Gauteng province.
The study indicated that male circumcision had a 60-75% preventative effect on potential HIV transmission. Evidence from other observational studies also showed the protective effect of male circumcision on HIV transmission.
However, the experts warned that male circumcision on its own was not enough to prevent HIV infection, and that circumcised males should still use condoms and reduce their number of partners.
In relation to abstinence, the experts’ meeting concluded that, while this might result in delays in young people starting having sex, this did not have a large impact on their lifetime risk of HIV infection once they started being sexually active.
The participants also noted that voluntary counselling and testing had not been shown 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, prevention of mother-to-child transmission, increased openness and reduced stigma, in addition to any impact for HIV prevention,” the experts said.
They concluded that interventions should focus on:
- Reducing the number of multiple and concurrent partnerships;
- Addressing male involvement and responsibility for sexual and reproductive health, HIV prevention and support, and reducing gender violence and sex with women much younger than themselves;
- Increasing consistent and correct condom use;
- Preparing for a possible roll-out of male circumcision; and
- Continuing to campaign for delayed sexual debuts in the context of increasing condom use and reducing multiple sexual partnerships.