Assessing the role of anal intercourse in the epidemiology of AIDS in Africa

• Published in: International journal of STD & AIDS Vol. 14; no. 7; p. 431
• Main Authors: Brody, Stuart, Potterat, John J
• Format: Journal Article
• Language: English
• Published: England 01-07-2003
• Subjects: Acquired Immunodeficiency Syndrome - epidemiology; Acquired Immunodeficiency Syndrome - etiology; Africa South of the Sahara - epidemiology; Female; Homosexuality - statistics & numerical data; Humans; Male; Rectal Diseases - diagnosis; Rectal Diseases - epidemiology; Sexual Behavior - ethnology; Sexual Behavior - statistics & numerical data; Africa South of the Sahara
• ISSN: 0956-4624
• DOI: 10.1258/095646203322025704

Public health authorities have long believed that the preponderance of AIDS cases in Africa are attributable to 'heterosexual transmission'; most people silently assume this rubric to indicate penile-vaginal intercourse only. Recent epidemiologic analyses suggest that the majority of HIV cases in sub-Saharan Africa may be due to non-sterile health care practices. The present paper reviews the anthropological, proctologic, and infectious disease literature, and argues that both homosexuality and heterosexual anal intercourse are more prevalent in Africa than has traditionally been believed. The authors hypothesize that perhaps the majority of HIV transmission not accounted for by iatrogenic exposure could be accounted for by unsuspected and unreported penile-anal intercourse. Given the authors' findings, properly conducted studies to measure this HIV transmission vector, while controlling for iatrogenic exposure confound, are clearly warranted in Africa and in countries with similar epidemiologic characteristics.