|HIV-1 Prevalence in Young Adults in South India|
HIV-1 Prevalence in Young Adults in South India
The Lancet 2006; 368: 114-115
Letter to the Editor
We agree with Rajesh Kumar and colleagues (1) that the encouraging decline in HIV-1 prevalence among young adults in south India justifies sustained investment in prevention. We caution, however, against a continued narrow focus on condom use among “high-risk” groups, in India or elsewhere. For example, UNAIDS has clearly stated that in Thailand, a country celebrated for containing its concentrated HIV/AIDS epidemic through sex workers' condom use, the greatest need for prevention efforts is now within the context of marriage and “regular relationships”. (2) Similar patterns and concerns are appearing in Brazil, where women represent an increasing proportion of infected individuals. (3)
Analyses of incidence, prevalence, and their causes among women and girls are vital to effective prevention efforts in all types of epidemics. In South Africa, for example, estimated HIV incidence among young women (aged 15–24 years) is eight times higher than among young men (4) owing to sexual coercion and violence, intergenerational and transactional sex, and gender discrimination in education and employment, among others.5 Supporting sex workers' use of condoms will not change these causes of infection.
Among women within countries, significant disparities also occur. In Malawi, where more than 15% of girls have sex before 15 years of age, (2) national antenatal clinic prevalence is stable, but prevalence in rural areas is increasing, and is disturbingly high among young pregnant women. (3) Again, the solution cannot simply be condoms for sex workers.
Reversing HIV/AIDS requires a policy paradigm shift and budget allocations to prevention programmes that address the several factors that make girls and women disproportionately vulnerable.
BRIAN A. BRINK
2. Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization. 2004 Report on the global AIDS epidemic. Geneva: UNAIDS, 2004:.
3. Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization. AIDS epidemic update: December 2005. Geneva: UNAIDS, 2004:.
4. Shisana O, Rehle T, Simbayi LC, et al. South African national HIV prevalence, HIV incidence, behaviour and communication survey. Pretoria: Human Sciences Research Council, 2005:.
5. Dunkle KL, Jewkes RK, Brown HC, et al. Gender-based violence, relationship power and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet 2004; 353: 1415-1421.
Originally published in The Lancet, July 8, 2006. Reprinted with permission. For more information visit www.thelancet.com.