Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections.

Schmid, GP; Buvé, A; Mugyenyi, P; Garnett, GPORCID logo; Hayes, RJORCID logo; Williams, BG; Calleja, JG; De Cock, KM; Whitworth, JAORCID logo; Kapiga, SHORCID logo; +5 more...Ghys, PD; Hankins, C; Zaba, B; Heimer, R; Boerma, JT and (2004) Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections. Lancet, 363 (9407). pp. 482-488. ISSN 0140-6736 DOI: 10.1016/S0140-6736(04)15497-4
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During the past year, a group has argued that unsafe injections are a major if not the main mode of HIV-1 transmission in sub-Saharan Africa. We review the main arguments used to question the epidemiological interpretations on the lead role of unsafe sex in HIV-1 transmission, and conclude there is no compelling evidence that unsafe injections are a predominant mode of HIV-1 transmission in sub-Saharan Africa. Conversely, though there is a clear need to eliminate all unsafe injections, epidemiological evidence indicates that sexual transmission continues to be by far the major mode of spread of HIV-1 in the region. Increased efforts are needed to reduce sexual transmission of HIV-1.

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