aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa bSchool of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa cSchool of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa dDepartment of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
Curr Opin HIV AIDS. 2014 Mar;9(2):115-25. doi: 10.1097/COH.0000000000000034.
A relatively neglected topic to date has been the occurrence of concentrated epidemics within generalized epidemic settings and the potential role of targeted interventions in such settings. We review recent studies in high-risk groups as well as findings relating to geographical heterogeneity and the potential for targeting 'high-transmission zones' in the 10 countries with highest HIV prevalence.
Our review of recent studies confirmed earlier findings that, even in the context of generalized epidemics, MSM have a substantially higher prevalence than the general population. Estimates of prevalence of HIV among people who inject drugs (PWID) in sub-Saharan African countries are rarely available and, when they are, often outdated. We identified recent studies of sex workers in Kenya and Uganda. In all three cases - MSM, PWID, and sex workers - HIV prevalence estimates are mostly based on convenience. Moreover, good estimates of the total size of these populations are not available. Our review of recent studies of high-risk populations defined on the basis of geography showed high levels of both new and existing infections in Kenya (slums), South Africa (peri-urban communities), and Uganda (fishing villages).
Recent empirical findings combined with evidence from phylogenetic studies and supported by mathematical models provide a clear rationale for testing the feasibility, acceptability, and effectiveness of targeted HIV prevention approaches in hyperendemic populations to supplement measures aimed at the general population.
迄今为止，一个相对被忽视的话题是集中性流行在广泛流行环境中的发生，以及在这种环境中目标干预的潜在作用。我们回顾了高危人群的最近研究，以及与地理异质性和针对艾滋病病毒流行率最高的 10 个国家的“高传播区”进行目标定位的潜力有关的发现。
我们对最近研究的综述证实了早期的发现，即在广泛流行的情况下，男男性行为者的患病率明显高于一般人群。在撒哈拉以南非洲国家，很少有关于注射吸毒者（PWID）艾滋病毒流行率的估计数，而且这些估计数往往已经过时。我们确定了最近在肯尼亚和乌干达进行的性工作者研究。在所有三种情况下（男男性行为者、PWID 和性工作者），艾滋病毒流行率的估计数主要基于便利性。此外，这些人群的总规模的准确估计数也不可用。我们对基于地理位置定义的高危人群的最近研究综述显示，肯尼亚（贫民窟）、南非（城市周边社区）和乌干达（渔村）的新感染和现有感染率都很高。
最近的实证发现，加上来自系统发育研究的证据，并得到数学模型的支持，为在高度流行地区测试有针对性的艾滋病毒预防方法的可行性、可接受性和有效性提供了明确的理由，以补充针对一般人群的措施。
