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

HIV Prevention among Female Sex Workers in Africa

Sex work occurs to meet the demand for sexual services and is a universal phenomenon. In Africa sex work takes many forms and is an important source of income for many women. Yet sex worker reproductive health needs remain largely unmet. The criminalisation of sex work; community and service provider stigma; violence; substance use and limited access to health services and prevention commodities contribute to the high HIV burden evident among female sex workers in Africa. Following UNAIDS' three pillar approach to HIV prevention and sex work we present an overview of current opportunities; barriers and suggestions to improve HIV prevention policy and programming for sex work in Africa. Universal access to a comprehensive package of HIV services is the first pillar. Reproductive health commodities; voluntary and anonymous HIV counselling and esting; treatment of sexually transmitted infections; HIV and opportunistic infections; harm reduction for substance use and psychosocial support services make up the recommended package of services. The second pillar is a sex worker-supportive environment. The inclusion of sex worker programmes within national HIV strategic planning; sex worker-led community mobilisation and the establishment of sex work community networks (comprised of sex workers; health service providers; law enforcers and other stakeholders) enable effective programme implementation and are recommended. The reduction of sex worker vulnerability and addressing structural issues form the final pillar. The decriminalisation of sex work; development of supportive policy; gender equality and economic development are key factors that need to be addressed to increase sex worker resilience. Evidence supports the public health benefit of human rights based approaches to HIV prevention; moralistic and restrictive policy and laws towards sex work are harmful and should be removed. The establishment of these pillars will increase sex worker safety and enhance the inclusiveness of the HIV response

Taxi 'Sugar Daddies' and Taxi queens: Male Taxi Driver Attitudes Regarding Transactional Relationships in the Western Cape; South Africa

Media reports are emerging on the phenomenon of young girls who travel with older mini-bus taxi drivers; and who are thought to have sex with the drivers in exchange for gifts and money. The extent to which such relationships might facilitate unsafe sexual practices and increased risks for both the men and the young women; often referred to as taxi queens; remains an important question in the light of the current challenges of HIV/AIDS in sub-Saharan Africa. However; very little research has been undertaken on this issue; especially regarding the perceptions and experiences of taxi drivers. Thus this paper aims to provide some preliminary findings on taxi drivers' attitudes and beliefs about taxi queens and their relationships with taxi drivers. A 22-item questionnaire was administered to 223 male taxi drivers in two regions in the Western Cape Province; South Africa. Taxi drivers in this study largely saw the relationship between taxi drivers and the young girls who ride with them as providing status for both the girls and drivers; and there seemed to be recognition of the transactional nature of the relationship between taxi drivers and taxi queens. The stigmatisation of young girls who ride with taxi drivers was evident. Drivers had knowledge and awareness of the risks of unsafe sex and supported condom use; although there appeared to be some uncertainty and confusion about the likelihood of HIV infection between drivers and girls. While taxi drivers recognised the role of alcohol in relationships with young girls; they seemed to deny that the abuse of drugs was common. The study highlights a number of key areas that need to be explored with men in the taxi industry; in order to address risk behaviours for both taxi drivers and the girls who ride with them

The Role of `Pimping' in the Mediation of Transactional Sex at a University Campus in Zimbabwe

The article focuses on a very specific form of transactional sex that exists at a university campus in Zimbabwe; which students refer to as `pimping.' Drawing extensively on the specific experiences of a male student pimp; the article demonstrates that; in practice; transactional sex takes different forms and is not always confined to two parties (namely; a woman and a man). In this case; `pimp-mediated' transactional sex introduces a third person - the pimp - into what is traditionally understood to be a relationship between the two parties and; in the process; dramatically transforms the social obligations that define this particular social relation. A major transformation that occurs in pimp-mediated transactional sex is that it makes the pimps; rather than the women; the central people in these relationships. This; I argue; makes transactional sex more efficient and potentially increases the female participants' vulnerability to HIV infection

Genital ulcer diseases among HIV_infected female commercial sex workers in Ibadan, Nigeria

We evaluated the prevalence and association of Genital Ulcer Diseases (GUDs) among HIV-1 infected female commercial sex workers (FCSWs) in Ibadan; Nigeria. A total of 25O FCSWs from brothels in Ibadan were tested for presence of antibodies to HIV and Syphilis. Pelvic examinations for signs of sexually transmitted infections (STIs) were carried out on the subjects. Endocervical and high vaginal swabs were collected from each of the subjects to establish laboratory diagnosis of STIs. Their age ranged from 15 to 55 years (Mean = 25.8yrs; SD =3.74). Majority (246/250) were Nigerians; while 1.6were from neighboring West African countries. Sixty four (25.6) of the subjects were positive for HIV-1 while seven (2.8) had dual HIV-1/2 infection. Analysis of the STIs showed that 49 (19.6) of the CSWs had GUDs. Herpes genitalis was the commonest GUDs as it occurred in 25 (10) of the subjects. Other STIs identified were chancroid (5.6); syphilis (4.0) and lymphogranuloma venerum (LGV) (4). Sixteen (64.0) of the CSWs with herpes genitalis had HIV-1 infection. The risk ratio of herpes genitalis for HIV acquisition was 3.0 (95CI: 2.0 - 4.4). Syphilis and chancroid were also foundto be significantly associated with increased risk of HIV infection (p0.0001). The adjusted odd ratios for Herpes genitalis; chancroid; and syphilis were 3.7(1-13.0; p0.05); 19.8 (2.7-13 .0; p0.05) and 19.1(1-231.0; p 0.05) respectively. There is need to educate FCSWs continually to adopt safer sexual behaviours; seek early diagnosis and treatment of GUDs to reduce their risk of transmitting HIV infection

Lifestyles and Routine Activities of South African Teenagers at Risk Of Being Trafficked For Involuntary Prostitution

The United Nations estimates that 79of teenage girls trafficked globally every year are forced into involuntary prostitution. About 247 000 South African children work in exploitative conditions; about 40 000 South African female teenagers work as prostitutes. This paper investigates lifestyles and routine activities of teenagers at risk of being trafficked for involuntary prostitution. The key concepts involuntary prostitution; intergenerational sex and exploitative conditions are defined in relation to the lifestyles and routine activities of South African female teenagers. Human trafficking for involuntary prostitution is described; based on a literature review. Lifestyle exposure and routine activities theories help to explain the potential victimisation of these teenagers in human trafficking for involuntary prostitution. Actual lifestyle and routine activities of South African teenagers and risky behaviours (substance abuse; intergenerational sex and child prostitution) are discussed as factors that make teens vulnerable to such trafficking. This paper recommends that human trafficking prevention efforts (awareness programmes and information campaigns) be directed at places frequented by human traffickers and teenagers in the absence of a capable guardian to reduce victimisation; as traffickers analyse the lifestyles and routine activities of their targets. South Africa should also interrogate entrenched practices such as intergenerational sex

Sex Work; Reform Initiatives and HIV/AIDS in Inner-City Johannesburg

The on-going criminalisation of sex work in South Africa; concurrent sexual partnerships; socio-economic vulnerability; migrant status and gender-based violence intensify sex workers' risk of contracting HIV. These factors combine to restrict the skills; ability and resources of sex workers to negotiate safer sex and to access HIV prevention; treatment and healthcare services. The paper situates the living and working conditions of sex workers in Hillbrow; an inner-city area of Johannesburg; within the South African legal context; especially in regard to current law reform initiatives regarding sex work; as well as the increasing anxiety about the influx of (sex) tourists during the 2010 FIFA World Cup. In addition; the paper describes an intervention by the Reproductive Health et HIV Research Unit at the University of the Witwatersrand; Johannesburg; an innovator in providing mobile healthcare services and education to hotel-based sex workers in Hillbrow. The paper contends that a legal-rights-approach to HIV risk and vulnerability; together with powerful public health considerations; render decriminalisation an imperative response to sex workers' material conditions

Poverty; Sexual Practices and Vulnerability of Female Sex Workers to HIV/AIDS Pandemic in Lagos Metropolis; Nigeria

"The objectives of this study were to know those factors that made women to join sex industry and effects of these factors on the practice of safe sex by female sex workers in Lagos metropolis within the context of HIV/AIDS pandemic. To achieve these objectives; quantitative and qualitative research methods were adopted. In the quantitative method; 320 female sex workers were sampled in a cross-sectional survey; while 20 in-depth interviews were conducted among the respondents in the qualitative method. Findings of the study showed that female sex workers in the metropolis were young ladies in their early twenties because the mean age of respondents was 23.8 years. Data on family socio-economic background revealed that 74.4of the respondents were from poor family; while 85.6of them grew up from one or two-room apartment. 35.0of the respondents stated that poverty made them to join sex industry. It is instructive to know that all the respondents had knowledge about the existence of HIV/AIDS and 81.9of them identified sexual intercourse as major route of HIV transmission. There is significant relationship between poverty; educational level; ever contraction of STIs; charging of higher price for ""flesh to flesh"" sexual contact and consistent use of condom by sex workers at P0.01. Specifically; only 24.7of the respondents were using condom regularly in each of the sexual acts. Poverty is a major factor that pushed young women into prostitution and this same factor hindered them from practising safe sex. Thus; programmes that will reduce poverty level should be developed in order to reduce rapid transmission of HIV infection in the country."

Sexual networks in Uganda: Casual and Commercial sex in a trading town

"A longitudinal study of the sexual behavior of high-risk men and women living in a trading town on the trans-Africa highway showed that distinct sexual networks operated within the town. Forty-eight prostitutes kept daily records for 6 months of all their sexual contacts including the occupation and place of residence of each client and the price paid. Details of 4573 sexual contacts of the women were recorded. Three classes of women were identified: (1) 20 ""high-class' women who charged a mean price of over US$4/- per contact. The majority of their clients were from large urban areas of Uganda (55) or neighbouring countries (32) - 70were truck-drivers or their mates; (2) 18 ""low-class' women; charging an average of US$0.4 per contanct; who were unskilled casual workers (58); (3) 10 women fell into an intermediate category in terms of price and the residence of their clients. Thirty-eight male potential clients were recruited in low-costs bars where some of the women worked. They provided similar details of their daily sexual contacts. All were resident in the toown and 22 had occupations which were classified as unskilled. Of the 1621 sexual contacts recorded by the men 25were with new partnets."

Prostitutes and free-lancers

The article discusses prostition and its implications with the deadly disease- AIDS. The article also mentions differences and similarities between prostitution and Free-lance activity by women

Prostitutes and free-lancers

The article discusses prostition and its implications with the deadly disease- AIDS. The article also mentions differences and similarities between prostitution and Free-lance activity by women

Enquete C.A.P.C. et de sero-prevalence VIH 1 a Mbaimboum; marche frontalier du Nord-Est du Cameroun : etude en population generale

Cette etude montre que le taux de seroprevalence pour l'infection a VIH 1 est preoccupant dans cette region frontaliere. La situation exceptionnelle de ce village a la conjonction du Tchad; de la Republique Centrafricaine et du Cameroun; sur un axe de commerce avec le Nigeria laisse a penser que l'avancee se fait le long des axes routiers par l'intermediaire de la prostitution. Ainsi les prostituees; les filles libres et les camionneurs sont des populations cibles qu'il conviendrait d'informer et d'eduquer rapidement et en priorite dans cette region si l'on ne veut pas voir la situation exploser dans un avenir proche

La syphilis venerienne chez les femmes africaines : un espace epidemiologique contraste

"Selon les enquetes serologiques recemment effectuees; la syphilis venerienne est tres inegalement frequente parmi les femmes adultes africaines. Sur le versant oriental du continent; les prevalences sont faibles a moderees dans les sites etudies au Nord-Est; sensiblement superieures de l'Ouganda a l'Afrique du Sud; de meme; sur l'autre versant; l'Afrique Centre-Ouest est bien davantage touchee que l'Afrique Occidentale. Partout les prostituees (ou assimilees) sont contaminees a un haut niveau. A l'inverse de l'hypothese enoncee dans la theorie des ""groupes-noyaux""; la collectivite generale apparait davantage investie par l'infection lorsque ces dernieres ont peu de partenaires"

Sex abuse

The problem of sex abuse of children in Uganda is taking an ever increasing dimension. At community level there are no feasible strategies in place to cope with this social menace. This situation has not been helped by the long period of silence that characterized the area of sexual abuse in the past. Inspite of continuous press reports about the problem; public awareness still remains relatively low. Even where cases have been reported; their handling has not matched their gravity

Comportement sexuel et rapports proteges en milieu urbain camerounais en 1992

Les auteurs rapportent les resultats de quatre enquetes menees en 1991 et 1992 dans la population generale masculine; les lieux de travail et ceux de detente nocturne des villes de Yaounde et de Douala. Cette population masculine; sexuellement tres active; est caracterisee par un partenariat sexuel multiple et un recours frequent aux prostituees. En moyenne 10 pour cent d'entre eux relatent un episode de maladies sexuellement transmissibles dans le semestre ecoule. La pratique des rapports proteges entre dans les moeurs car 62 a 79 pour cent des personnes interrogees ont deja utilise un preservatif mais moins de 10 pour cent en font un usage systematique

Les determinants culturels et psychosociaux des comportements predisposant la femme camerounaise a l'infection a VIH

Les auteurs presentent une partie des resultats de deux enquetes longitudinales realisees en fevrier 1993 dans les villes de Nkongsamba et d'Edea. La population parente etait constituee des personnes de sexe feminin agees de 15 a 49 ans. Les resultats relatifs au comportement sexuel; indiquent que autant a Nkongsamba qu'a Edea; les femmes sont assez impregnees de l'information sur l'existence du SIDA (97 pour cent; 99 pour cent). Dans les deux milieux; le premier rapport sexuel de la femme intervient en moyenne a 16 ans; et la premiere utilisation du condom a 20 ans. A Edea; les cas de rapports sexuels a risque par vagabondage prostitutionnel interviennent des 18 ans et concernent 14 pour cent des femmes; contre 20 ans et 6 pour cent seulement a Nkongsamba

L'experience de filles libres educatrices a Yaounde dans la prevention des MST et du SIDA

Dans le cadre du Programme National de Lutte contre le SIDA au Cameroun; l'utilisation des filles libres educatrices a ete une des strategies adoptees ciblant les groupes a haut risque. Des resultats preliminaires ont ete presentes ailleurs et ont montre son positif impact. Afin d'evaluer cette strategie; une enquete de connaissances; attitudes; croyances et pratiques (ACP) aupres des filles qui pratiquaient la prostitution a Yaounde a ete faite. Cette enquete a eu pour but non seulement de faire le point sur les differentes actions educatrices menees aupres de ce groupe mais aussi de mettre sur pied des methodes d'education plus efficaces