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HIV in sub-Sahara Africa
May 22, 2003

I read in one of your answers that in sub-Saharan Africa, the rate of HIV transmission in males is equivalent to females as opposed to most parts of the world. What do you attribute this to? Anatomy, HIV-strain, or what?

Response from Mr. Kull

Some studies have demonstrated that heterosexual transmission of HIV in regions of sub-Saharan Africa looks different than heterosexual transmission in the U.S. While the rates of transmission from female-male are not equivalent to male-female transmission (male-female is still more efficient), the differences were not significant when compared to data conducted here in the U.S. There have been different hypotheses about this phenomenon: the prevalence of HIV and STIs and higher numbers of uncircumcised men are some factors that are examined.

There is increasing, reliable, scientific evidence that heterosexual men who are uncircumcised have a greater risk of being infected during insertive vaginal intercourse when compared to uncircumcised men. This is clear in many regions in Africa, where the rate of infection is much higher among uncircumcised heterosexual men. The interior of the foreskin is a mucous membrane that contains Langerhans cells, cells that are known to be vehicles for HIV's passage to the immune system. Circumcision is a much more common practice in the United States, which might account for the lower rate of transmission to heterosexual men here.

There is reliable evidence that the presence of genital STIs among men in Africa also increase their risk for infection. There is also the obvious fact that heterosexual men in Africa are much more likely to have sexual contact with an HIV infected woman than heterosexual men in the United States, increasing their odds for exposure and infection significantly.

RMK



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