Abstract

PIP: Of the approximately 15 million HIV infections that have occurred since the epidemic began, over 10 million have been transmitted heterosexually. Although there have been studies to show that HIV-1 is relatively inefficiently transmitted heterosexually and substantially less readily transmitted than is herpes simplex 2 virus or human papilloma virus, studies in Kenya have identified 5 factors that facilitate heterosexual spread of HIV-1: 1) promiscuity, 2) other sexually transmitted diseases (ulcers, particularly chancroid), 3) cervical ectopia, 4) uncircumcised men, and 5) increased titers of HIV-1 secreted in the genital secretions of immunosuppressed patients. Poverty, illiteracy, discrimination and stigmatization, gender inequality, low respect for human rights, and political and civil unrest are also underlying determinants of HIV epidemiology. The World Health Organization Global Program on AIDS has mobilized resources to control AIDS, but culturally inappropriate interventions can be detrimental to slowing and stopping the spread of HIV-1. HIV prevention is difficult because of the stigmatization associated with it, the long incubation period negates awareness of cause and effect, and sexual behavior is poorly understood in all societies. Specific interventions comprise: 1) a defined mission with strong links to the national head of state and annual review of the program goals and strategies; 2) mass media and targeted educational campaigns to increase public awareness of AIDS and encourage behavior change; and 3) the synergism between HIV and other sexually transmitted diseases provides an opportunity for targeted interventions. Among specific interventions are: 1) Behavioral interventions for vulnerable groups. In Thailand condom promotion, prostitute and brothel registration, and education of those in male risk groups resulted in a 70% reduction in cases of STDs. 2) Improved clinical services for sexually transmitted infections. 3) Research to understand sexual health. 4) Integration of HIV- and STD-control programs. Physical and chemical barriers should be the major strategy of reduction and prevention of HIV transmission.