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  • Title: Inter-relationships between HIV infection and other sexually transmitted diseases.
    Author: Mhalu FS.
    Journal: East Afr Med J; 1990 Jul; 67(7):512-7. PubMed ID: 2226231.
    Abstract:
    The HIV is a typical sexually transmitted disease (STD) agent which depends for its transmission through sex on contact between raw body tissues of infected and uninfected individuals independent of sexual inclination. The dynamics of HIV transmission and its control in a community can be inferred from studying the socio-cultural and epidemiological aspects of acute STD. There is strong evidence to suggest that the main cause of rampant heterosexual transmission of the HIV in sub-Saharan Africa in contrast to the rarer heterosexual HIV transmission in Europe and the USA is the high prevalence of ulcerative STD in Africa. Studying the trend and response to treatment of conventional acute STD are quick and indirect ways of assessing the impact of control measures against AIDS and HIV infection in an HIV endemic area. Further research is needed to determine the extent and detailed mechanism of interaction between HIV infection and other STDs as well as studying the efficacy of AIDS control through control of other STDs. Having reviewed the interrelation between HIV infection and other STDs, the author concludes that enough evidence exists to designate some STDs -- especially genital ulcer diseases (GUD) -- as a risk factor for HIV transmission. Additionally, the evidence suggests that sub-Saharan Africa's rampant heterosexual transmission of HIV, which depends contact between raw body tissue of infected and uninfected individuals, is mainly due to the high prevalence of ulcerative STDs in the region. Studies have shown a connection between the presence of HIV and past history of STD. In one such study in Zaire, 50% of AIDS cases had a past history of STDs, compared to 14% of controls. In Tanzania and Rwanda, the prevalence of a pst STD history among AIDS cases were 35% and 70%, respectively. Unlike the US and Europe, where homosexual intercourse and intravenous drug use are the major risk factors for HIV, heterosexual intercourse is the major mode of HIV transmission in sub-Saharan Africa. While studies in the US show that male to female transmission of HIV occurs in 1 out of every 500 sexual exposures, the rate is far higher in sub-Saharan Africa. Researchers have identified various possible risk factors for heterosexual transmission of HIV, and the only contrasting difference between sub-Saharan Africa and the US and Europe is the high prevalence of STDs -- including IUDs -- in Africa. Not all STDs may facilitate HIV transmission. A study at a London STD clinic suggests that gonorrhea does not appear to act as a cofactor of HIV transmission. The author concludes that these findings indicate that AIDS control activities in Africa require corresponding STD control programs.
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