Limits...
Sexual risk factors for HIV infection in early and advanced HIV epidemics in sub-Saharan Africa: systematic overview of 68 epidemiological studies.

Chen L, Jha P, Stirling B, Sgaier SK, Daid T, Kaul R, Nagelkerke N, International Studies of HIV/AIDS (ISHA) Investigato - PLoS ONE (2007)

Bottom Line: We used random-effects methods and stratified results by gender, time, background HIV prevalence rates and other variables.These risks changed little over time and stratification by lower and higher HIV background prevalence showed that risk ratios for most variables were larger in high prevalence settings.Even in high prevalence settings, prevention among people with high rates of partner change, such as female sex workers and their male clients, is likely to reduce transmission overall.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT

Background: It is commonly assumed that sexual risk factors for heterosexual HIV transmission in sub-Saharan Africa, such as multi-partner sex, paid sex and co-infections, become less important as HIV epidemics mature and prevalence increases.

Methods and findings: We conducted a systematic review of 68 African epidemiological studies from 1986 to 2006 involving 17,000 HIV positive adults and 73,000 controls. We used random-effects methods and stratified results by gender, time, background HIV prevalence rates and other variables. The number of sex partners, history of paid sex, and infection with herpes simplex virus (HSV-2) or other sexually-transmitted infections (STIs) each showed significant associations with HIV infection. Among the general population, the odds ratio (OR) of HIV infection for women reporting 3+ sex partners versus 0-2 was 3.64 (95%CI [2.87-4.62]), with similar risks for men. About 9% of infected women reported ever having been paid for sex, versus 4% of control women (OR = 2.29, [1.45-3.62]). About 31% of infected men reported ever paying for sex versus 18% of uninfected men (OR = 1.75, [1.30-2.36]). HSV-2 infection carried the largest risk of HIV infection: OR = 4.62, [2.85-7.47] in women, and OR = 6.97, [4.68-10.38] in men. These risks changed little over time and stratification by lower and higher HIV background prevalence showed that risk ratios for most variables were larger in high prevalence settings. Among uninfected controls, the male-female differences in the number of sex partners and in paid sex were more extreme in the higher HIV prevalence settings than in the lower prevalence settings.

Significance: Multi-partner sex, paid sex, STIs and HSV-2 infection are as important to HIV transmission in advanced as in early HIV epidemics. Even in high prevalence settings, prevention among people with high rates of partner change, such as female sex workers and their male clients, is likely to reduce transmission overall.

Show MeSH

Related in: MedlinePlus

Begg's funnel plots with 95% CI for publication bias by risk factors (p<0.05 indicates a significant bias).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC1994584&req=5

pone-0001001-g008: Begg's funnel plots with 95% CI for publication bias by risk factors (p<0.05 indicates a significant bias).

Mentions: Funnel plots of the effects and the Egger rank correlation test did not show evidence of publication bias (Figure 8). There was no evidence suggesting that smaller studies with a larger standard error were more likely to report a positive association. Significant heterogeneity was found among studies in most of the risk factors. However, this heterogeneity fell when studies were stratified by population (general or high-risk), or by background HIV prevalence. Table 2 summarizes results for the 26 studies that adjusted for various possible confounding factors (as shown in Table S1). The adjusted odds ratios for most risk factors were similar to crude odds ratios, including a markedly higher excess risk of HIV infection from HSV-2 infection in males and females. Similarly, heterogeneity among individual studies was similar for the adjusted and crude odds ratios.


Sexual risk factors for HIV infection in early and advanced HIV epidemics in sub-Saharan Africa: systematic overview of 68 epidemiological studies.

Chen L, Jha P, Stirling B, Sgaier SK, Daid T, Kaul R, Nagelkerke N, International Studies of HIV/AIDS (ISHA) Investigato - PLoS ONE (2007)

Begg's funnel plots with 95% CI for publication bias by risk factors (p<0.05 indicates a significant bias).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC1994584&req=5

pone-0001001-g008: Begg's funnel plots with 95% CI for publication bias by risk factors (p<0.05 indicates a significant bias).
Mentions: Funnel plots of the effects and the Egger rank correlation test did not show evidence of publication bias (Figure 8). There was no evidence suggesting that smaller studies with a larger standard error were more likely to report a positive association. Significant heterogeneity was found among studies in most of the risk factors. However, this heterogeneity fell when studies were stratified by population (general or high-risk), or by background HIV prevalence. Table 2 summarizes results for the 26 studies that adjusted for various possible confounding factors (as shown in Table S1). The adjusted odds ratios for most risk factors were similar to crude odds ratios, including a markedly higher excess risk of HIV infection from HSV-2 infection in males and females. Similarly, heterogeneity among individual studies was similar for the adjusted and crude odds ratios.

Bottom Line: We used random-effects methods and stratified results by gender, time, background HIV prevalence rates and other variables.These risks changed little over time and stratification by lower and higher HIV background prevalence showed that risk ratios for most variables were larger in high prevalence settings.Even in high prevalence settings, prevention among people with high rates of partner change, such as female sex workers and their male clients, is likely to reduce transmission overall.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT

Background: It is commonly assumed that sexual risk factors for heterosexual HIV transmission in sub-Saharan Africa, such as multi-partner sex, paid sex and co-infections, become less important as HIV epidemics mature and prevalence increases.

Methods and findings: We conducted a systematic review of 68 African epidemiological studies from 1986 to 2006 involving 17,000 HIV positive adults and 73,000 controls. We used random-effects methods and stratified results by gender, time, background HIV prevalence rates and other variables. The number of sex partners, history of paid sex, and infection with herpes simplex virus (HSV-2) or other sexually-transmitted infections (STIs) each showed significant associations with HIV infection. Among the general population, the odds ratio (OR) of HIV infection for women reporting 3+ sex partners versus 0-2 was 3.64 (95%CI [2.87-4.62]), with similar risks for men. About 9% of infected women reported ever having been paid for sex, versus 4% of control women (OR = 2.29, [1.45-3.62]). About 31% of infected men reported ever paying for sex versus 18% of uninfected men (OR = 1.75, [1.30-2.36]). HSV-2 infection carried the largest risk of HIV infection: OR = 4.62, [2.85-7.47] in women, and OR = 6.97, [4.68-10.38] in men. These risks changed little over time and stratification by lower and higher HIV background prevalence showed that risk ratios for most variables were larger in high prevalence settings. Among uninfected controls, the male-female differences in the number of sex partners and in paid sex were more extreme in the higher HIV prevalence settings than in the lower prevalence settings.

Significance: Multi-partner sex, paid sex, STIs and HSV-2 infection are as important to HIV transmission in advanced as in early HIV epidemics. Even in high prevalence settings, prevention among people with high rates of partner change, such as female sex workers and their male clients, is likely to reduce transmission overall.

Show MeSH
Related in: MedlinePlus