Kevin de Cock briefly admitted that the threat of an heterosexual AIDS pandemic outside of Africa had disappeared, but the pandemic is well and alive in Africa where it is affecting more and more heterosexual couples as observed in a study by Dr Kristin Dunkle and colleagues from the Emory Center for AIDS Research in the US and published in The Lancet.

The Atlanta team analysed Demographic and Health Surveys (DHS) data from 1739 Zambian women, 540 Zambian men, 1176 Rwandan women, and 606 Rwandan men. Using various analyses models they concluded from their most conservative model that “most heterosexual HIV infections in both men and women in urban Zambia and Rwanda every year are probably transmitted within marriage.”

The role of pre-marital and extra-marital sexual relations (or relations outside cohabiting couple) is key to one of the spouse bringing HIV in the household (usually men). The number of extra-conjugal partner was the highest in the Zambian men group (14·8%) who reported having more than one non-cohabiting sex partner during the past 12 months. A relatively low number but a high number is not a prerequisite for the epidemics to propagate; what matters is the concurrency of these experiences as previously documented by Helen Epstein and Elizabeth Pisani in their respective book.

For the researcher, the study strengthen the assertion that marriage and cohabitation should be a key focus for HIV-prevention efforts.

“To reduce HIV transmission, couples need to know their joint serostatus and have access to information which enables them to reduce the risk of infection both within and outside the union. This is especially important for women, who might not have the cultural freedom to negotiate condom use and sexual activity within a union”, wrote the researchers.

Using statistical modelling the researcher predicted that “voluntary counselling and testing for couples, which reduced the incidence of HIV among serodiscordant urban cohabiting couples from 20% to 7% per year [...] could prevent 35·7% to 60·3% of heterosexual infections in this population.”

Meanwhile, on the other side of the pond, The Washington Post reports on “a survey conducted by the Centers for Disease Control and Prevention of HIV-AIDS data from 33 states between 2001 and 2006 [that] revealed a distressing trend: HIV infection in young gay men rose 12 percent a year. For African Americans in that group of 13- to 24-year-olds, the annual increase was 15 percent.”

More than a clear indication that different mechanisms are leading to different epidemics and that there is a need to tackle the population at risk where they are.

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