Points to Consider:
Responses to HIV/AIDS
in Africa, Asia, and the Caribbean
David Gisselquist
Table of Contents
Chapter 1: Ignoring HIV from Healthcare in the Worst AIDS Epidemics
Chapter 2: The AIDS Epidemic Begins, 1900-60
Chapter 3: AIDS Spreads Silently, 1960-81
Chapter 4: Recognizing AIDS in Two Epidemic Patterns, 1981-84
Chapter 5: From First Tests to a Consensus on Risks, 1984-88
Chapter 6a, 6b: Things Go Badly Wrong, 1989-2009
Chapter 7: Not Listening, and not Explaining the Epidemic, 1989-2009
Chapter 8: How much HIV Infection Comes from Blood Exposures?
Chapter 9: Failing to Provide Safe Healthcare, 1989-2009
Chapter 10: How People Can Stop HIV Transmission during Healthcare
List of Tables and Figures
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Table 5.1: |
Countries with the worst HIV epidemics in 1988 |
|
Table 5.2: |
HIV prevalence (percentages) in selected populations in generalized epidemics, 1984-88 |
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Table 6.1: |
World overview of HIV epidemic expansion, 1988-2007 |
|
Table 6.2: |
Recent distribution of HIV infections in African countries with the worst epidemics in 1988 |
|
Figure 6.1: |
HIV prevalence in pregnant women attending urban antenatal clinics, for nine countries in Southern Africa, 1985-2005 |
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Table 6.3: |
Distribution of HIV infections in Southern African countries with the worst current epidemics |
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Table 6.4: |
Distribution of HIV infections in other African countries with at least 5 percent HIV prevalence in adults |
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Table 6.5: |
Distribution of HIV infections in selected African countries with low-level generalized epidemics |
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Table 6.6: |
Distribution of HIV infections in Asian and Caribbean countries with low-level generalized epidemics |
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Table 7.1: |
Proportions of men and women aged 15-49 years reporting 0-1 sexual partners in the past year, and proportions of HIV infections in such men and women, in 24 countries with generalized epidemics |
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Table 7.2: |
Funders for selected studies that followed HIV-positive Africans who did not know they were infected |
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Table 7.3: |
HIV prevalence in virgin men and women aged 15-49 years in countries with generalized epidemics |
|
Table 7.4: |
Percentage of men circumcised, and HIV prevalence in circumcised and uncircumcised men in 13 countries with generalized epidemics |
|
Figure 7.1: |
HIV prevalence in women by age in Southern Africa |
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Table 7.5: |
HIV infection in couples in countries with generalized epidemics |
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Table 8.1: |
Estimates of the proportion of incident HIV infections from injections |
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Table 9.1: |
Documented outbreaks of HIV infection from medical procedures |
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Annex Table 1: |
Estimated HIV prevalence in countries with generalized epidemics, 2007 |
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Annex Table 2: |
Sources for national surveys, 2001-09 |
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Annex Figure 1: |
Political map of Africa, 2007 |
Preface
In the year since Adonis & Abbey published Points to Consider, new reports have added information about both the history and current situation of the HIV epidemic. For example, research based on colonial archives links high prevalence of hepatitis C infection in Cameroon to injections during 1930-1960 (see Chapter 2). Another study reports the discovery of the second oldest known HIV, from 1960, and its implications for the history of HIV (see Chapter 2). Other new studies link HIV to medical injections and other blood exposures in Malawi, Uganda, and elsewhere (see Chapter 8). Several chapters and the Statistical Annex incorporate new information on HIV prevalence from national surveys.
This book builds on nine years of research, writing, and discussion about HIV transmission in generalized epidemics. Steve Minkin and Lucy Hancock encouraged me from 1999, when I began to look for information on blood exposures as risks for HIV infection. Yvan Hutin, Jules Millogo, Selma Khamassi, Lone Simonsen, Mark Miller, and many others whom I met through the Safe Injection Global Network, guided me with information and questions. Much of the evidence and arguments presented in this book have been assembled in collaboration with colleagues and co-authors, including John Potterat, Mariette Correa, Francois Vachon, Garance Upham, Stuart Brody, Devon Brewer, Eric Friedman, Rich Rothenberg, Ernest Drucker, Valsa Madhava, Steven Q. Muth, Deodatta Gore, Lillian Salerno, Moses Okinyi, and Tobias Ounga.
The World Health Organization, South Africa’s Human Sciences Research Council, Global Health through Education, Training and Service, Mariette Correa, Retractable Technologies, Inc., Hindustan Syringes and Medical Devices, Ltd., and Star Syringe, Ltd., provided occasional small grants for research and travel on topics related to this book.
The Hershey Medical Center and library staff, including Sharon Daugherty, Marie Fitzsimmons, and many others, provided access to journals and other research assistance.
John Gordon, Francois Vachon, Garance Upham, Mariette Correa, Brian Foley, Tom O’Connell, Jane Perry, Janine Jagger, David Sobel, Sarah Melendez, Robert Steinglass, Joe Lieberson, Savanna Reid, and others not named read and criticized all or parts of early drafts, averting many errors. I’ll claim the remaining errors.
I thank Vidyadhar Gadgil for preparing the manuscript for publication, and Jideofor Adibe at Adonis & Abbey for his support in bringing this book to market.
Finally, I thank my wife, Carol, for financial assistance and good advice on arguments and content.
David Gisselquist
April 2009
Glossary*
AIDS acquired immunodeficiency syndrome
antibody a molecule that bodies produce to target and control a specific virus, parasite, or toxin
BCG Bacillus Calmette-Guerin, a vaccine against tuberculosis
CAR Central African Republic
CDC United States Centers for Disease Control and Prevention
CRF circulating recombinant form
DPT diphtheria, pertussis, tetanus
DRC Democratic Republic of Congo
EPI Expanded Programme on Immunization
HIV human immunodeficiency virus
HIV-1 human immunodeficiency virus type 1
HIV-2 human immunodeficiency virus type 2
IDU injection drug user
incidence the rate at which an event, such as a new infection, occurs in a population; often given in events per 100 persons per year
MSM men who have sex with men
POST patient observed sterile treatment
prevalence the proportion of a population that has a condition such as an infection at a specified time
sentinel survey a survey to determine HIV prevalence; sentinel surveys are characteristically anonymous (names are removed from samples before testing) and are repeated from year to year to see trends in prevalence
SIDA syndrome d’immuno deficience acquise
SIGN Safe Injection Global Network
SIV simian immunodeficiency virus
UK United Kingdom
UN United Nations
UNAIDS Joint United Nations Programme on AIDS
UNESCO United Nations Educational, Scientific and Cultural Organization
UNICEF United Nations Children’s Fund
US United States
USAID United States Agency for International Development
virus a large molecule that can reproduce inside living cells
WHO World Health Organization
* For abbreviations which occur only once in the text, the full form is given immediately after the term in the text.
Second Edition, May 2009, revised and formatted for the web
First Edition, February 2008, available in paperback and hardback from:
Adonis & Abbey Publishers, Ltd
P.O. Box 43418
London, SE11 4XZ
Paperback: GBP25, US$30
Hardback: GBP50, US$79
Published by Adonis & Abbey Publishers Ltd
Copyright 2007 © David Gisselquist
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
ISBN: 9781905068265(HB)/9781905068487 (PB)
The moral right of the author has been asserted
All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted at any time or by any means without the prior permission of the publisher
Suggested citations:
Gisselquist D. Points to Consider: Response to HIV/AIDS in Africa, Asia, and the Caribbean, 2nd ed. London: Adonis & Abbey, 2008.
Gisselquist D. Points to Consider: Response to HIV/AIDS in Africa, Asia, and the Caribbean, 2nd ed. Available from: http://davidgisselquist.googlepages.com/pointstoconsider