Epidemiology Sexually Transmitted Infections: The Iceberg Under
South Africa's AIDS Epidemic
12/22/97
Vaccine Weekly
The HIV epidemic continues to ravage South Africa, and data from the
Medical Research Council's rural research unit at Hlabisa show that one in
10 young women there became infected with HIV in 1997.
The high prevalence of sexually transmitted infections (STIs) is a major
factor in the rampant growth of HIV, and researchers estimate that about
a quarter of the country's sexually active population may have at least one
STI.
A large part of the MRC's research into preventing AIDS is now focusing
on STIs, as it appears that managing these infections will help alleviate the
burden of HIV. Studies in Tanzania found that effective treatment of STIs
reduced HIV infections by 42 percent.
A range of studies by MRC researchers in KwaZulu-Natal has found that
77 percent of sex workers and over 50 percent of pregnant women have
at least one STI. The rate of HIV infection is also high, with 50 percent of
sex workers being infected, 16 percent of pregnant women, and 24
percent of women attending family planning clinics. The researchers found
that only 10 percent of sex workers reported using a condom more than
half the time.
"South Africa suffers a huge and largely hidden burden of STIs. In the
general community at Hlabisa, about 25 percent of the women have at
least one STI. Half of these have no symptoms, so don't seek treatment.
The remainder seek treatment relatively late. When they do, only about a
quarter receive the correct drugs!" said Dr. David Wilkinson who heads
up the rural research unit at Hlabisa. He and colleague Dr. Gita Ramjee
reported these findings at a December 3, 1997, MRC's management
meeting with the Department of Health to discuss policy implications of
MRC research.
"Clearly, an immediate priority for addressing the situation is to ensure that
patients with an STI who seek care are treated correctly, the first time.
Correct treatment includes being given the right drugs, being counselled,
receiving partner notification cards, and receiving condoms," he said.
Informing the community through mass media campaigns that STIs are
treatable at a clinic or doctor's practice, that partners should be treated
too, and that condoms can prevent these infections would also help
alleviate the burden of STIs, he added.
Meanwhile, MRC research is continuing on a novel microbicide - a vaginal
contraceptive gel - known as Advantage 24 which is being tested in sex
workers in and around Ladysmith in the Natal Midlands to determine if it
is effective in preventing STIs as well as HIV. The active ingredient is
nonoxynol-9 which has been shown to be active against HIV and STIs.
"An acceptability study of the product showed that it was acceptable to
the women and did not compromise any traditional sexual practices," said
Dr. Gita Ramjee, a specialist scientist at the MRC in Durban. "A
three-month study also showed that the gel was safe to use in the short
term. We are doing further research to assess the safety and efficacy
Advantage 24 for preventing HIV and STIs. We expect the results of
these projects within two years," she said.
The MRC also recently established a research unit at the University of
Natal to focus on genital ulcers which play an important role in assisting
the transmission of HIV.
"Mass treatment and health education are solutions to the STI problem,
but we have to remember that we are dealing with sexual activity, and
changing behavior is very difficult, says Prof. Wim Sturm, the Director of
the new Genital Ulcer Disease Research Unit. "Vaccinating all children
aged 10-12 would be an effective solution and ideally should give
immunity for at least 30 years. However, developing such a vaccine needs
detailed knowledge of how the organism interacts with the host, and this is
where we hope to advance scientific knowledge," he said.
"The MRC has been able to strengthen its AIDS/HIV research efforts
through collaborative initiatives and by obtaining grants from the Wellcome
Trust in the United Kingdom and the National Institutes of Health in the
United States. We are hoping to play a leading role in vaccine and HIV
prevention trials," said Dr. Salim Abdool Karim, head of the MRC's
Centre for Epidemiological Research in Southern Africa (CERSA).
"The MRC remains very committed to research on preventing and
controlling AIDS, and commends the efforts of all those, particularly the
AIDS non-governmental organizations, who are trying to alleviate the
burden, and care for those affected and infected," said Dr. Abdool Karim.
He said the MRC was proud to have been associated with the recent
AIDS Review which "was an enlightening experience. We look forward to
the recommendations being implemented," he said. |
