New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda : an analysis of survey and clinical data. Commentary
Identifieur interne : 000538 ( PascalFrancis/Corpus ); précédent : 000537; suivant : 000539New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda : an analysis of survey and clinical data. Commentary
Auteurs : Rebecca Bunnell ; Peter Cherutich ; Kristin L. Dunkle ; Rob Stephenson ; Etienne Karita ; Elwyn Chomba ; Kayitesi Kayitenkore ; Cheswa Vwalika ; Lauren Greenberg ; Susan AllenSource :
- Lancet : (British edition) [ 0140-6736 ] ; 2008.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Background Sub-Saharan Africa has a high rate of HIV infection, most of which is attributable to heterosexual transmission. Few attempts have been made to assess the extent of HIV transmission within marriages, and HIV-prevention efforts remain focused on abstinence and non-marital sex. We aimed to estimate the proportion of heterosexual transmission of HIV which occurs within married or cohabiting couples in urban Zambia and Rwanda each year. Methods We used population-based data from Demographic and Health Surveys (DHS) on heterosexual behaviour in Zambia in 2001-02 and in Rwanda in 2005. We also used data on the HIV serostatus of married or cohabiting couples and non-cohabiting couples that was collected through a voluntary counselling and testing service for urban couples in Lusaka, in Zambia, and Kigali, in Rwanda. We estimated the probability that an individual would acquire an incident HIV infection from a cohabiting or non-cohabiting sexual partner, and then the proportion of total heterosexual HIV transmission which occurs within married or cohabiting couples in these settings each year. Findings We analysed DHS data from 1739 Zambian women, 540 Zambian men, 1176 Rwandan women, and 606 Rwandan men. Under our base model, we estimated that 55-1% to 92.7% of new heterosexually acquired HIV infections among adults in urban Zambia and Rwanda occurred within serodiscordant marital or cohabiting relationships, depending on the sex of the index partner and on location. Under our extended model, which incorporated the higher rates of reported condom use that we found with non-cohabiting partners, we estimated that 60.3% to 94.2% of new heterosexually acquired infections occurred within marriage or cohabitation. We estimated that an intervention for couples which reduced transmission in serodiscordant urban cohabiting couples from 20% to 7% every year could avert 35.7% to 60.3% of heterosexually transmitted HIV infections that would otherwise occur. Interpretation Since most heterosexual HIV transmission for both men and women in urban Zambia and Rwanda takes place within marriage or cohabitation, voluntary counselling and testing for couples should be promoted, as should other evidence-based interventions that target heterosexual couples. Funding US National Institute of Mental Health, National Institute of Child Health and Human Development, National Institute of Allergy and Infectious Diseases, Fogarty AIDS International Training and Research Program, Emory Center for AIDS Research, and the International AIDS Vaccine Initiative.
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NO : | PASCAL 08-0314896 INIST |
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ET : | New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda : an analysis of survey and clinical data. Commentary |
AU : | BUNNELL (Rebecca); CHERUTICH (Peter); DUNKLE (Kristin L.); STEPHENSON (Rob); KARITA (Etienne); CHOMBA (Elwyn); KAYITENKORE (Kayitesi); VWALIKA (Cheswa); GREENBERG (Lauren); ALLEN (Susan) |
AF : | Global AIDS Program, Centers for Disease Control and Prevention-Kenya, PO Box 606-00621Village Market/Nairobi/Kenya (1 aut.); National AIDS/STD Control Programme, Ministry of Health/Nairobi/Kenya (2 aut.); Department of Behavioral Sciences and Health Education and Emory Center for AIDS Research, Rollins School of Public Health, Emory University/Atlanta, Georgia/Etats-Unis (3 aut.); Hubert Department of Global Health, Rollins School of Public Health, Emory University/Atlanta, Georgia/Etats-Unis (4 aut., 9 aut., 10 aut.); Projet San Francisco, Rwanda-Zambia HIV Research Group/Kigali/Rwanda (5 aut., 7 aut., 10 aut.); Zambia-Emory HIV Research Project, Rwanda-Zambia HIV Research Group/Lusaka/Zambie (6 aut., 8 aut., 10 aut.) |
DT : | Publication en série; Article; Commentaire; Niveau analytique |
SO : | Lancet : (British edition); ISSN 0140-6736; Coden LANCAO; Royaume-Uni; Da. 2008; Vol. 371; No. 9631; 2148-2150, 2183-2191 [12 p.]; Bibl. 52 ref. |
LA : | Anglais |
EA : | Background Sub-Saharan Africa has a high rate of HIV infection, most of which is attributable to heterosexual transmission. Few attempts have been made to assess the extent of HIV transmission within marriages, and HIV-prevention efforts remain focused on abstinence and non-marital sex. We aimed to estimate the proportion of heterosexual transmission of HIV which occurs within married or cohabiting couples in urban Zambia and Rwanda each year. Methods We used population-based data from Demographic and Health Surveys (DHS) on heterosexual behaviour in Zambia in 2001-02 and in Rwanda in 2005. We also used data on the HIV serostatus of married or cohabiting couples and non-cohabiting couples that was collected through a voluntary counselling and testing service for urban couples in Lusaka, in Zambia, and Kigali, in Rwanda. We estimated the probability that an individual would acquire an incident HIV infection from a cohabiting or non-cohabiting sexual partner, and then the proportion of total heterosexual HIV transmission which occurs within married or cohabiting couples in these settings each year. Findings We analysed DHS data from 1739 Zambian women, 540 Zambian men, 1176 Rwandan women, and 606 Rwandan men. Under our base model, we estimated that 55-1% to 92.7% of new heterosexually acquired HIV infections among adults in urban Zambia and Rwanda occurred within serodiscordant marital or cohabiting relationships, depending on the sex of the index partner and on location. Under our extended model, which incorporated the higher rates of reported condom use that we found with non-cohabiting partners, we estimated that 60.3% to 94.2% of new heterosexually acquired infections occurred within marriage or cohabitation. We estimated that an intervention for couples which reduced transmission in serodiscordant urban cohabiting couples from 20% to 7% every year could avert 35.7% to 60.3% of heterosexually transmitted HIV infections that would otherwise occur. Interpretation Since most heterosexual HIV transmission for both men and women in urban Zambia and Rwanda takes place within marriage or cohabitation, voluntary counselling and testing for couples should be promoted, as should other evidence-based interventions that target heterosexual couples. Funding US National Institute of Mental Health, National Institute of Child Health and Human Development, National Institute of Allergy and Infectious Diseases, Fogarty AIDS International Training and Research Program, Emory Center for AIDS Research, and the International AIDS Vaccine Initiative. |
CC : | 002B01; 002B05C02D; 002B06D01 |
FD : | SIDA; Couple; Milieu urbain; Zambie; Rwanda; Surveillance; Enquête; Donnée médicale; Médecine |
FG : | Virose; Infection; Afrique; Immunodéficit; Immunopathologie |
ED : | AIDS; Couple; Urban environment; Zambia; Rwanda; Surveillance; Survey; Medical data; Medicine |
EG : | Viral disease; Infection; Africa; Immune deficiency; Immunopathology |
SD : | SIDA; Pareja; Medio urbano; Zambia; Ruanda; Vigilancia; Encuesta; Datos Médicos; Medicina |
LO : | INIST-5004.354000161788900100 |
ID : | 08-0314896 |
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Pascal:08-0314896Le document en format XML
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term>
<term>Couple</term>
<term>Medical data</term>
<term>Medicine</term>
<term>Rwanda</term>
<term>Surveillance</term>
<term>Survey</term>
<term>Urban environment</term>
<term>Zambia</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term>
<term>Couple</term>
<term>Milieu urbain</term>
<term>Zambie</term>
<term>Rwanda</term>
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<front><div type="abstract" xml:lang="en">Background Sub-Saharan Africa has a high rate of HIV infection, most of which is attributable to heterosexual transmission. Few attempts have been made to assess the extent of HIV transmission within marriages, and HIV-prevention efforts remain focused on abstinence and non-marital sex. We aimed to estimate the proportion of heterosexual transmission of HIV which occurs within married or cohabiting couples in urban Zambia and Rwanda each year. Methods We used population-based data from Demographic and Health Surveys (DHS) on heterosexual behaviour in Zambia in 2001-02 and in Rwanda in 2005. We also used data on the HIV serostatus of married or cohabiting couples and non-cohabiting couples that was collected through a voluntary counselling and testing service for urban couples in Lusaka, in Zambia, and Kigali, in Rwanda. We estimated the probability that an individual would acquire an incident HIV infection from a cohabiting or non-cohabiting sexual partner, and then the proportion of total heterosexual HIV transmission which occurs within married or cohabiting couples in these settings each year. Findings We analysed DHS data from 1739 Zambian women, 540 Zambian men, 1176 Rwandan women, and 606 Rwandan men. Under our base model, we estimated that 55-1% to 92.7% of new heterosexually acquired HIV infections among adults in urban Zambia and Rwanda occurred within serodiscordant marital or cohabiting relationships, depending on the sex of the index partner and on location. Under our extended model, which incorporated the higher rates of reported condom use that we found with non-cohabiting partners, we estimated that 60.3% to 94.2% of new heterosexually acquired infections occurred within marriage or cohabitation. We estimated that an intervention for couples which reduced transmission in serodiscordant urban cohabiting couples from 20% to 7% every year could avert 35.7% to 60.3% of heterosexually transmitted HIV infections that would otherwise occur. Interpretation Since most heterosexual HIV transmission for both men and women in urban Zambia and Rwanda takes place within marriage or cohabitation, voluntary counselling and testing for couples should be promoted, as should other evidence-based interventions that target heterosexual couples. Funding US National Institute of Mental Health, National Institute of Child Health and Human Development, National Institute of Allergy and Infectious Diseases, Fogarty AIDS International Training and Research Program, Emory Center for AIDS Research, and the International AIDS Vaccine Initiative.</div>
</front>
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<fA11 i1="01" i2="1"><s1>BUNNELL (Rebecca)</s1>
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<fA11 i1="03" i2="1"><s1>DUNKLE (Kristin L.)</s1>
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<fA11 i1="06" i2="1"><s1>CHOMBA (Elwyn)</s1>
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<fA11 i1="07" i2="1"><s1>KAYITENKORE (Kayitesi)</s1>
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<fA14 i1="01"><s1>Global AIDS Program, Centers for Disease Control and Prevention-Kenya, PO Box 606-00621Village Market</s1>
<s2>Nairobi</s2>
<s3>KEN</s3>
<sZ>1 aut.</sZ>
</fA14>
<fA14 i1="02"><s1>National AIDS/STD Control Programme, Ministry of Health</s1>
<s2>Nairobi</s2>
<s3>KEN</s3>
<sZ>2 aut.</sZ>
</fA14>
<fA14 i1="03"><s1>Department of Behavioral Sciences and Health Education and Emory Center for AIDS Research, Rollins School of Public Health, Emory University</s1>
<s2>Atlanta, Georgia</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
</fA14>
<fA14 i1="04"><s1>Hubert Department of Global Health, Rollins School of Public Health, Emory University</s1>
<s2>Atlanta, Georgia</s2>
<s3>USA</s3>
<sZ>4 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
</fA14>
<fA14 i1="05"><s1>Projet San Francisco, Rwanda-Zambia HIV Research Group</s1>
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<sZ>5 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>10 aut.</sZ>
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<fA14 i1="06"><s1>Zambia-Emory HIV Research Project, Rwanda-Zambia HIV Research Group</s1>
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<s3>ZMB</s3>
<sZ>6 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>10 aut.</sZ>
</fA14>
<fA20><s2>2148-2150, 2183-2191 [12 p.]</s2>
</fA20>
<fA21><s1>2008</s1>
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<fA45><s0>52 ref.</s0>
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<fC01 i1="01" l="ENG"><s0>Background Sub-Saharan Africa has a high rate of HIV infection, most of which is attributable to heterosexual transmission. Few attempts have been made to assess the extent of HIV transmission within marriages, and HIV-prevention efforts remain focused on abstinence and non-marital sex. We aimed to estimate the proportion of heterosexual transmission of HIV which occurs within married or cohabiting couples in urban Zambia and Rwanda each year. Methods We used population-based data from Demographic and Health Surveys (DHS) on heterosexual behaviour in Zambia in 2001-02 and in Rwanda in 2005. We also used data on the HIV serostatus of married or cohabiting couples and non-cohabiting couples that was collected through a voluntary counselling and testing service for urban couples in Lusaka, in Zambia, and Kigali, in Rwanda. We estimated the probability that an individual would acquire an incident HIV infection from a cohabiting or non-cohabiting sexual partner, and then the proportion of total heterosexual HIV transmission which occurs within married or cohabiting couples in these settings each year. Findings We analysed DHS data from 1739 Zambian women, 540 Zambian men, 1176 Rwandan women, and 606 Rwandan men. Under our base model, we estimated that 55-1% to 92.7% of new heterosexually acquired HIV infections among adults in urban Zambia and Rwanda occurred within serodiscordant marital or cohabiting relationships, depending on the sex of the index partner and on location. Under our extended model, which incorporated the higher rates of reported condom use that we found with non-cohabiting partners, we estimated that 60.3% to 94.2% of new heterosexually acquired infections occurred within marriage or cohabitation. We estimated that an intervention for couples which reduced transmission in serodiscordant urban cohabiting couples from 20% to 7% every year could avert 35.7% to 60.3% of heterosexually transmitted HIV infections that would otherwise occur. Interpretation Since most heterosexual HIV transmission for both men and women in urban Zambia and Rwanda takes place within marriage or cohabitation, voluntary counselling and testing for couples should be promoted, as should other evidence-based interventions that target heterosexual couples. Funding US National Institute of Mental Health, National Institute of Child Health and Human Development, National Institute of Allergy and Infectious Diseases, Fogarty AIDS International Training and Research Program, Emory Center for AIDS Research, and the International AIDS Vaccine Initiative.</s0>
</fC01>
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<s5>01</s5>
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<s5>01</s5>
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<s5>02</s5>
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<s5>02</s5>
</fC03>
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<s5>02</s5>
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<s5>05</s5>
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<s2>NG</s2>
<s5>05</s5>
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<s2>NG</s2>
<s5>06</s5>
</fC03>
<fC03 i1="05" i2="X" l="ENG"><s0>Rwanda</s0>
<s2>NG</s2>
<s5>06</s5>
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<s2>NG</s2>
<s5>06</s5>
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<fC03 i1="06" i2="X" l="FRE"><s0>Surveillance</s0>
<s5>08</s5>
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<fC03 i1="06" i2="X" l="ENG"><s0>Surveillance</s0>
<s5>08</s5>
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<s5>08</s5>
</fC03>
<fC03 i1="07" i2="X" l="FRE"><s0>Enquête</s0>
<s5>09</s5>
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<fC03 i1="07" i2="X" l="ENG"><s0>Survey</s0>
<s5>09</s5>
</fC03>
<fC03 i1="07" i2="X" l="SPA"><s0>Encuesta</s0>
<s5>09</s5>
</fC03>
<fC03 i1="08" i2="X" l="FRE"><s0>Donnée médicale</s0>
<s5>11</s5>
</fC03>
<fC03 i1="08" i2="X" l="ENG"><s0>Medical data</s0>
<s5>11</s5>
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<s5>11</s5>
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<s5>12</s5>
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<s5>12</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE"><s0>Virose</s0>
</fC07>
<fC07 i1="01" i2="X" l="ENG"><s0>Viral disease</s0>
</fC07>
<fC07 i1="01" i2="X" l="SPA"><s0>Virosis</s0>
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<fC07 i1="02" i2="X" l="FRE"><s0>Infection</s0>
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<s2>NG</s2>
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<s2>NG</s2>
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<s5>37</s5>
</fC07>
<fC07 i1="04" i2="X" l="ENG"><s0>Immune deficiency</s0>
<s5>37</s5>
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<s5>37</s5>
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<server><NO>PASCAL 08-0314896 INIST</NO>
<ET>New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda : an analysis of survey and clinical data. Commentary</ET>
<AU>BUNNELL (Rebecca); CHERUTICH (Peter); DUNKLE (Kristin L.); STEPHENSON (Rob); KARITA (Etienne); CHOMBA (Elwyn); KAYITENKORE (Kayitesi); VWALIKA (Cheswa); GREENBERG (Lauren); ALLEN (Susan)</AU>
<AF>Global AIDS Program, Centers for Disease Control and Prevention-Kenya, PO Box 606-00621Village Market/Nairobi/Kenya (1 aut.); National AIDS/STD Control Programme, Ministry of Health/Nairobi/Kenya (2 aut.); Department of Behavioral Sciences and Health Education and Emory Center for AIDS Research, Rollins School of Public Health, Emory University/Atlanta, Georgia/Etats-Unis (3 aut.); Hubert Department of Global Health, Rollins School of Public Health, Emory University/Atlanta, Georgia/Etats-Unis (4 aut., 9 aut., 10 aut.); Projet San Francisco, Rwanda-Zambia HIV Research Group/Kigali/Rwanda (5 aut., 7 aut., 10 aut.); Zambia-Emory HIV Research Project, Rwanda-Zambia HIV Research Group/Lusaka/Zambie (6 aut., 8 aut., 10 aut.)</AF>
<DT>Publication en série; Article; Commentaire; Niveau analytique</DT>
<SO>Lancet : (British edition); ISSN 0140-6736; Coden LANCAO; Royaume-Uni; Da. 2008; Vol. 371; No. 9631; 2148-2150, 2183-2191 [12 p.]; Bibl. 52 ref.</SO>
<LA>Anglais</LA>
<EA>Background Sub-Saharan Africa has a high rate of HIV infection, most of which is attributable to heterosexual transmission. Few attempts have been made to assess the extent of HIV transmission within marriages, and HIV-prevention efforts remain focused on abstinence and non-marital sex. We aimed to estimate the proportion of heterosexual transmission of HIV which occurs within married or cohabiting couples in urban Zambia and Rwanda each year. Methods We used population-based data from Demographic and Health Surveys (DHS) on heterosexual behaviour in Zambia in 2001-02 and in Rwanda in 2005. We also used data on the HIV serostatus of married or cohabiting couples and non-cohabiting couples that was collected through a voluntary counselling and testing service for urban couples in Lusaka, in Zambia, and Kigali, in Rwanda. We estimated the probability that an individual would acquire an incident HIV infection from a cohabiting or non-cohabiting sexual partner, and then the proportion of total heterosexual HIV transmission which occurs within married or cohabiting couples in these settings each year. Findings We analysed DHS data from 1739 Zambian women, 540 Zambian men, 1176 Rwandan women, and 606 Rwandan men. Under our base model, we estimated that 55-1% to 92.7% of new heterosexually acquired HIV infections among adults in urban Zambia and Rwanda occurred within serodiscordant marital or cohabiting relationships, depending on the sex of the index partner and on location. Under our extended model, which incorporated the higher rates of reported condom use that we found with non-cohabiting partners, we estimated that 60.3% to 94.2% of new heterosexually acquired infections occurred within marriage or cohabitation. We estimated that an intervention for couples which reduced transmission in serodiscordant urban cohabiting couples from 20% to 7% every year could avert 35.7% to 60.3% of heterosexually transmitted HIV infections that would otherwise occur. Interpretation Since most heterosexual HIV transmission for both men and women in urban Zambia and Rwanda takes place within marriage or cohabitation, voluntary counselling and testing for couples should be promoted, as should other evidence-based interventions that target heterosexual couples. Funding US National Institute of Mental Health, National Institute of Child Health and Human Development, National Institute of Allergy and Infectious Diseases, Fogarty AIDS International Training and Research Program, Emory Center for AIDS Research, and the International AIDS Vaccine Initiative.</EA>
<CC>002B01; 002B05C02D; 002B06D01</CC>
<FD>SIDA; Couple; Milieu urbain; Zambie; Rwanda; Surveillance; Enquête; Donnée médicale; Médecine</FD>
<FG>Virose; Infection; Afrique; Immunodéficit; Immunopathologie</FG>
<ED>AIDS; Couple; Urban environment; Zambia; Rwanda; Surveillance; Survey; Medical data; Medicine</ED>
<EG>Viral disease; Infection; Africa; Immune deficiency; Immunopathology</EG>
<SD>SIDA; Pareja; Medio urbano; Zambia; Ruanda; Vigilancia; Encuesta; Datos Médicos; Medicina</SD>
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