BACKGROUND: The proportion of heterosexual HIV transmission in sub-Saharan Africa that occurs within cohabiting partnerships, compared with that in single people or extra-couple relationships, is widely debated. We estimated the proportional contribution of different routes of transmission to new HIV infections. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is crucial to target intervention efforts. METHODS: We built a mechanistic model of HIV transmission with data from Demographic and Health Surveys (DHS) for 2003-2011, of 27,201 cohabiting couples (men aged 15-59 years and women aged 15-49 years) from 18 sub-Saharan African countries with information about relationship duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and coverage of antiretroviral therapy (ART). We then estimated the proportion of recorded infections in surveyed cohabiting couples that occurred before couple formation, between couple members, and because of extra-couple intercourse. FINDINGS: In surveyed couples, we estimated that extra-couple transmission accounted for 27-61% of all HIV infections in men and 21-51% of all those in women, with ranges showing intercountry variation. We estimated that in 2011, extra-couple transmission accounted for 32-65% of new incident HIV infections in men in cohabiting couples, and 10-47% of new infections in women in such couples. Our findings suggest that transmission within couples occurs largely from men to women; however, the latter sex have a very high-risk period before couple formation. INTERPRETATION: Because of the large contribution of extra-couple transmission to new HIV infections, interventions for HIV prevention should target the general sexually active population and not only serodiscordant couples. FUNDING: US National Institutes of Health, US National Science Foundation, and J S McDonnell Foundation.
BACKGROUND: The proportion of heterosexual HIV transmission in sub-Saharan Africa that occurs within cohabiting partnerships, compared with that in single people or extra-couple relationships, is widely debated. We estimated the proportional contribution of different routes of transmission to new HIV infections. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is crucial to target intervention efforts. METHODS: We built a mechanistic model of HIV transmission with data from Demographic and Health Surveys (DHS) for 2003-2011, of 27,201 cohabiting couples (men aged 15-59 years and women aged 15-49 years) from 18 sub-Saharan African countries with information about relationship duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and coverage of antiretroviral therapy (ART). We then estimated the proportion of recorded infections in surveyed cohabiting couples that occurred before couple formation, between couple members, and because of extra-couple intercourse. FINDINGS: In surveyed couples, we estimated that extra-couple transmission accounted for 27-61% of all HIV infections in men and 21-51% of all those in women, with ranges showing intercountry variation. We estimated that in 2011, extra-couple transmission accounted for 32-65% of new incident HIV infections in men in cohabiting couples, and 10-47% of new infections in women in such couples. Our findings suggest that transmission within couples occurs largely from men to women; however, the latter sex have a very high-risk period before couple formation. INTERPRETATION: Because of the large contribution of extra-couple transmission to new HIV infections, interventions for HIV prevention should target the general sexually active population and not only serodiscordant couples. FUNDING: US National Institutes of Health, US National Science Foundation, and J S McDonnell Foundation.
Authors: Susan Allen; Jareen Meinzen-Derr; Michele Kautzman; Isaac Zulu; Stanley Trask; Ulgen Fideli; Rosemary Musonda; Francis Kasolo; Feng Gao; Alan Haworth Journal: AIDS Date: 2003-03-28 Impact factor: 4.177
Authors: Stanley A Trask; Cynthia A Derdeyn; Ulgen Fideli; Yalu Chen; Sreelatha Meleth; Francis Kasolo; Rosemary Musonda; Eric Hunter; Feng Gao; Susan Allen; Beatrice H Hahn Journal: J Virol Date: 2002-01 Impact factor: 5.103
Authors: Kristin L Dunkle; Rachel K Jewkes; Heather C Brown; Glenda E Gray; James A McIntryre; Siobán D Harlow Journal: Soc Sci Med Date: 2004-10 Impact factor: 4.634
Authors: Mark N Lurie; Brian G Williams; Khangelani Zuma; David Mkaya-Mwamburi; Geoff P Garnett; Michael D Sweat; Joel Gittelsohn; Salim S Abdool Karim Journal: AIDS Date: 2003-10-17 Impact factor: 4.177
Authors: Nora E Rosenberg; Lauren A Graybill; Austin Wesevich; Nuala McGrath; Carol E Golin; Suzanne Maman; Mercy Tsidya; Limbikani Chimndozi; Irving F Hoffman; Mina C Hosseinipour; William C Miller Journal: AIDS Behav Date: 2018-06
Authors: Nora E Rosenberg; Lauren A Graybill; Austin Wesevich; Nuala McGrath; Carol E Golin; Suzanne Maman; Nivedita Bhushan; Mercy Tsidya; Limbikani Chimndozi; Irving F Hoffman; Mina C Hosseinipour; William C Miller Journal: J Acquir Immune Defic Syndr Date: 2017-08-01 Impact factor: 3.731
Authors: Connie Celum; Jared M Baeten; James P Hughes; Ruanne Barnabas; Albert Liu; Heidi Van Rooyen; Susan Buchbinder Journal: J Acquir Immune Defic Syndr Date: 2013-07 Impact factor: 3.731
Authors: Hans Heesterbeek; Roy M Anderson; Viggo Andreasen; Shweta Bansal; Daniela De Angelis; Chris Dye; Ken T D Eames; W John Edmunds; Simon D W Frost; Sebastian Funk; T Deirdre Hollingsworth; Thomas House; Valerie Isham; Petra Klepac; Justin Lessler; James O Lloyd-Smith; C Jessica E Metcalf; Denis Mollison; Lorenzo Pellis; Juliet R C Pulliam; Mick G Roberts; Cecile Viboud Journal: Science Date: 2015-03-13 Impact factor: 47.728
Authors: John C Chapola; Kendra Hatfield-Timajchy; Agatha K Bula; Stacey Hurst; Lameck Chinula; Athena P Kourtis; Jennifer H Tang Journal: Afr J AIDS Res Date: 2021-03 Impact factor: 1.300