Gisselquist David
SAHARA J. 2004 Aug;1(2):114-27. doi: 10.1080/17290376.2004.9724834.
From the mid-1970s, seven countries in sub-Saharan Africa have experienced civil disorders and wars lasting for at least 10 years. In two-- Sierra Leone during 1991-2002, and Somalia from 1988 and continuing--adult HIV prevalence remained below 1%. In the Democratic Republic of the Congo, HIV prevalence appears to have stabilised during post-1991 civil disorder and war. Limited information from Angola (civil war 1975 -2002) and Liberia (civil disorder and war from 1989 and continuing) suggests low HIV prevalence. Mozambique's HIV prevalence was near 1% after its 1975 - 1992 civil war, but increased dramatically in the first post-war decade. Across African countries with long-term wars, HIV seems to have spread more slowly than in most neighbouring countries at peace. This evidence contributes to the ongoing debate about the factors that explain differential epidemic trajectories, a debate which is crucial to the design of HIV prevention programmes. One possible explanation for slow epidemic growth in wartime is that unsterile health care accounts for an important proportion of HIV transmission during peacetime, but much less when wars disrupt health services. However, other explanations are also possible. The roles of sex and blood exposures in HIV epidemics in war and peace await empirical determination.
自20世纪70年代中期以来，撒哈拉以南非洲的七个国家经历了持续至少10年的内乱和战争。在其中两个国家——1991年至2002年期间的塞拉利昂，以及自1988年起至今的索马里——成人艾滋病毒感染率一直低于1%。在刚果民主共和国，艾滋病毒感染率在1991年后的内乱和战争期间似乎趋于稳定。来自安哥拉（1975年至2002年内战）和利比里亚（1989年起持续的内乱和战争）的有限信息表明艾滋病毒感染率较低。莫桑比克在1975年至1992年内战后艾滋病毒感染率接近1%，但在战后的第一个十年中大幅上升。在经历长期战争的非洲国家中，艾滋病毒的传播似乎比大多数处于和平状态的邻国更为缓慢。这一证据为正在进行的关于解释不同流行轨迹的因素的辩论提供了依据，这场辩论对于艾滋病毒预防方案的设计至关重要。战时疫情增长缓慢的一个可能解释是，在和平时期，不卫生的医疗保健在艾滋病毒传播中占很大比例，但战争扰乱卫生服务时，这一比例要小得多。然而，其他解释也是有可能的。战争与和平时期性接触和血液接触在艾滋病毒流行中的作用有待实证确定。
