Rewriting the Narrative of the Epidemiology of HIV in Sub-Saharan Africa

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

Demand for Programs for Key Populations in Africa from Countries Receiving International Donor Assistance

There has been increasing attention in recent years to the HIV prevention; treatment; and care needs of key populations in Africa; in particular men who have sex with men (MSM); injection drug users (IDU); and female sex workers (FSW). While several major donors have undertaken efforts to prioritize these groups; it remains unclear which African countries are actively seeking donor support for these programs. For this analysis; we reviewed publicly available proposal and budget documentation from the US PEPFAR for fiscal years 2007 through 2010 and Rounds 1 through 10 of the Global Fund to Fight AIDS; Tuberculosis and Malaria for 40 countries in sub-Saharan Africa. Of the 164 searchable documents retrieved; nearly two-thirds contained at least one program serving FSW (65; 107 proposals); less than one-third contained at least one program serving MSM (29; 47 proposals); and a minority proposed programming for IDU (13; 21 proposals). Demand for these programs was highly concentrated in a subset of countries. Epidemiological data for at least one key population was included in a majority of these proposals (63; 67 proposals); but in many cases these data were not linked to programs

Illicit drug use in South Africa: Findings from a 2008 national population-based survey

Objective. The aim of this secondary analysis of the South African National HIV; Incidence; Behaviour and Communication (SABSSM) 2008 survey is to provide current data on illicit drug use that could assist in the development and implementation of effective substance abuse policies and intervention programmes aimed at these populations in South Africa.Method. A multistage random population sample of 15 828 people age ?15 (56.3 women) was included in the survey. Illicit drug use was assessed by 2 sections of the Alcohol; Smoking and Substance use Involvement Screening Test (ASSIST). Frequency analyses for different age groups; geolocality; educational level; income; and population group were calculated; as were odds ratios for these variables regarding combined illicit drug use.Results. Current cannabis use was reported by 3.3 of the population sample - 6.1 of the men and 1.2 of the women - and the use of combined all-other illicit drugs (cocaine; amphetamines; inhalants; sedatives; hallucinogens; opiates) was reported by 1.8 of the participants. Coloured men (14.3) were most likely; and Indian or Asian women (0.6) least likely; to be cannabis users. Illicit drug use (combined) among men was associated with the 20 - 34 year age group and the coloured and white population groups; and among women in the younger age groups; the coloured and white population groups; and low and higher income.Conclusion. An increase of cannabis and other illicit drug prevalence rates was observed from 2005 (2.1) to 2008 (3.3) in the population sample. Multilevel interventions are required to target illicit drug users; in addition to creating awareness in the general population of the problems associated with illicit drug use. There is a need to address illicit drug use in national and provincial policy planning and intervention efforts and; in terms of treatment; a need to ensure that treatment practitioners are adequately trained to address illicit drug use. Future prospective studies are necessary to assess the impact of illicit drug use