A number of countries now consistently report an HIV prevalence of between 1–5% in pregnant women attending antenatal clinics, indicating that the presence of HIV among the general population is sufficient for sexual networking to drive the epidemic. In these epidemic scenarios, HIV transmission in serodiscordant couples and multiple partner relationships that give rise to sexual networks in the general population — account for the majority of new infections. Most-at-risk populations such as sex workers and their clients are still at risk of HIV infection. However, the behaviours of very large sub-populations, with relatively low risk (such as unmarried young people, and married women and men who do not regularly visit sex workers or have multiple partners) contribute to the larger proportion of new infections. In a generalized epidemic with more than 5% adult prevalence, no sexually active person is “low risk”.
In some parts of Africa, there is research evidence on sexual networks which shows that longer-term multiple concurrent partnerships intensify the epidemic (1). Broad social norms that lead to multiple sexual partner relations and/or norms and policies that prevent individuals or populations from protecting themselves (for example gender norms that lessen girls’ access to education and information), are directly implicated in the epidemic dynamics. As more women are living with HIV, a significant number of new infections are from mother-to-child transmission (2).
(1) Morris M, Levine R, Weaver M (2004). Sexual networks and HIV Programme Design. The Synergy Project, Washington, DC.
(2) WHO/UNFPA (2006). Glion Consultation on Strengthening the Linkages between Reproductive Health and HIV/AIDS: Family Planning and HIV/AIDS in Women and Children. World Health Organization, Geneva.