Mounting anomalies in the epidemiology of HIV in Africa: cry the beloved paradigm

In North America Europe and many parts of Asia the ignition of regional epidemics and rapid HIV transmission has been associated principally with the sharing of contaminated injecting equipment and with anal intercourse. Though heterosexual intercourse has been virtually the sole explanation offered for the AIDS epidemic in sub-Saharan Africa to our knowledge in no other part of the world has penile-vaginal exposure (as opposed to “heterosexual sex”) been demonstrated to initiate or sustain rapid HIV propagation. HIV is not transmitted by “sex” but only by specific risky practices. It is not transmitted by “injections” but only by contaminated implements which need to be clearly differentiated as to type and frequency of injection and by the conditions of the exposure setting. In virtually all societies affected by HIV to date both routes seem to play important roles. If we are to understand and intervene in each of these epidemics well-designed studies at both the population and individual levels are urgently needed. It is vital that these be properly controlled for parenteral exposure specific sexual practices and other co-factors and the complex and specific social patterns and networks that accompany them. (excerpt)