Department of Epidemiology at the Johns Hopkins School of Public Health, Baltimore, MD, USA.
SAHARA J. 2012;9(3):127-30. doi: 10.1080/17290376.2012.743787.
The fight against HIV remains complicated with contracting donor resources and high burden of HIV among reproductive age adults still often limiting independent economic development. In the widespread HIV epidemics of sub-Saharan Africa (SSA), it is proposed that key populations with specific HIV acquisition and transmission risk factors, such as men who have sex with men (MSM), female sex workers (FSW), and people who use drugs (PUD), are less relevant because HIV transmission is sustained in the general population with average HIV acquisition and transmission risks. However, the understanding that key populations are less relevant in the epidemics of Africa is based on the surveillance system from which these populations are mostly excluded. Outside of SSA, the epidemics of HIV are generally concentrated in the same populations that are excluded from the primary HIV surveillance systems in SSA. The manuscripts included in this special issue present convincing data that FSW, MSM, and PUD carry disproportionate burdens of HIV wherever studied in SSA, are underrepresented in HIV programs and research, and require specific HIV prevention services. These manuscripts collectively suggest that the only effective path forward is one that transcends denial and stigma and focuses on systematically collecting data on all populations at risk for HIV. In addition, there is a need to move to a third generation of HIV surveillance as the current one inadvertently devalues HIV surveillance among key populations in the context of widespread HIV epidemics. Overall, the data reviewed here demonstrate that the dynamics of HIV in Africa are complex and achieving an AIDS-free generation necessitates acceptance of that complexity in all HIV surveillance, research, and prevention, treatment, and care programs.
抗击艾滋病的斗争仍然很复杂，因为获得捐助资源和艾滋病毒在育龄成年人中的负担仍然很高，这往往限制了独立的经济发展。在撒哈拉以南非洲（SSA）广泛流行的艾滋病中，有人提出，具有特定艾滋病获得和传播风险因素的关键人群，如男男性行为者（MSM）、性工作者（FSW）和吸毒者（PUD），与艾滋病的相关性较低，因为艾滋病的传播是在具有平均艾滋病获得和传播风险的普通人群中持续的。然而，认为关键人群在非洲的艾滋病流行中相关性较低的理解是基于这些人群大多被排除在外的监测系统。在 SSA 之外，艾滋病的流行一般集中在同样的人群中，这些人群被 SSA 的主要艾滋病监测系统排除在外。本特刊中的论文提供了令人信服的证据，表明无论在 SSA 的何处研究，性工作者、男男性行为者和吸毒者都承担着不成比例的艾滋病负担，在艾滋病规划和研究中代表性不足，需要特定的艾滋病预防服务。这些论文共同表明，唯一有效的前进道路是超越否认和污名化，系统地收集所有艾滋病高危人群的数据。此外，需要向第三代艾滋病监测转变，因为目前的监测在广泛的艾滋病流行背景下无意中贬低了关键人群中的艾滋病监测。总的来说，这里审查的数据表明，非洲的艾滋病动态是复杂的，要实现无艾滋病的一代，就必须在所有艾滋病监测、研究以及预防、治疗和护理方案中接受这种复杂性。
