Preventing sexual transmission of HIV -- new ideas from sub-Saharan Africa [editorial]

Programs aimed at preventing transmission of HIV type-1 (HIV-1) have focused primarily on uninfected people in high-risk populations. A study conducted in Uganda suggests that it may be equally important to identify HIV-1-infected persons in order to try to reduce their infectiousness. The study by Quinn et al. demonstrated that the blood viral burden determines the efficiency of its sexual transmission. Other factors associated with the transmission of the virus among the subjects included genital discharge or dysuria presence of more advanced disease in HIV-infected partner as well as biologic factors. Although it is reasonable to assume that antiretroviral therapy reduces the viral burden in both blood and genital secretions the results of the Ugandan study did not prove this point. Instead the results of the study demonstrated that HIV-1 could still be cultured from blood and genital secretions of some patients receiving antiretroviral therapy. However there are other ways to reduce the viral burden such as treatment of systemic or genital tract infections. Furthermore findings showed that circumcision protected the male subjects from contracting HIV-1 from their HIV-1-positive partners.