Gisselquist David, Potterat John J, Brody Stuart, Vachon Francois
Int J STD AIDS. 2003 Mar;14(3):148-61. doi: 10.1258/095646203762869151.
The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988. We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures. Early studies did not resolve questions about direction of causation (between injections and HIV) and confound (between injections and STD). Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence. We urge renewed, evidence-based, investigations into the proportion of African HIV from non-sexual exposures.
有影响力的艾滋病专家们达成的共识是，异性传播在非洲成年人的艾滋病毒感染中占比90%，这一观点最晚在1988年就已出现。我们研究了截至1988年可得的证据，包括将艾滋病毒与性行为、医疗保健及社会经济变量相关联的风险衡量指标、儿童中的艾滋病毒情况，以及妓女和性病患者感染艾滋病毒的风险。现有证据表明，医疗保健接触导致的艾滋病毒感染比性传播更多。在一般人群研究中，粗略的风险衡量指标显示，成年人中超过一半的艾滋病毒感染与医疗保健接触有关。早期研究未能解决因果关系方向（注射与艾滋病毒之间）以及混杂因素（注射与性病之间）的问题。对非洲性观念的先入之见以及维持公众对医疗保健信任的愿望，可能促使人们对证据不予重视。我们敦促对非性接触导致非洲艾滋病毒感染的比例重新展开基于证据的调查。
