High Prevalence of HIV Infection Among Youth in a South African Mining Town Is Associated with HSV-2 Seropositivity and Sexual Behaviour

South Africa is experiencing one of the most rapidly growing HIV epidemics in the world. In 1990 the prevalence of HIV infection among women attending antenatal clinics was less than one percent. By 1999 the prevalence had increased to 23 percent. By the end of 1999 national prevalence had reached 23 percent. Most studies of prevalence have concentrated on adults. Yet, the authors maintain that young women are at particularly high risk of HIV infection in resource-poor countries.

In this study, the researchers found an extremely high level of HIV among young women (34%) and men (9%) between ages 14 and 24 in the Carletonville district of South Africa. HIV prevalence among women age 24 was 66 percent -- one of the highest rates ever reported in a general population. The authors did not attribute these findings to increased sexual activity among women. In almost all surveys carried out across Eastern and Southern Africa by the World Health Organization, men report a higher turnover of partners before marriage than women, and in this study the mean number of partners was 4.7 for men and 2.6 for women.

According to the authors, HIV is more easily transmitted from men to women than from women to men. Studies have shown that, in the absence of other risk factors, men are two to three times more likely to transmit HIV to women than vice versa. The estimates of transmissibility of HIV from men to women in the Carletonville study are significantly higher than this, however. The authors attributed the findings to the high rates of HIV transmission from men to women and to the role of herpes simplex virus type 2 (HSV-2) in the spread of HIV.

Recent studies have shown that viral load is an important predictor in the risk of heterosexual HIV transmission, and viral loads are likely to be higher in South Africa than in Europe or the United States due to the reduced availability of effective drugs and treatment. In the Carletonville study, HSV-2 status was the most significant factor associated with HIV status for both men and women. Men infected with HSV-2 were seven times more likely to also be HIV-positive than those who did not have HSV-2. HSV-2 acts as a co-factor in HIV transmission by causing genital ulcers that both increase the susceptibility of the uninfected to infection by HIV and increase the infectivity of those who already carry the virus.

Reducing HIV transmission in this population is a major challenge. Genital herpes can only be treated at considerable cost, and there is no vaccine currently available. Reducing transmission depends upon communication campaigns aimed at alerting the population to the relatively mild manifestation of genital herpes and the need to abstain from sexual contact while lesions persist. In addition, it is important to find ways to persuade young people to reduce their number of sexual partners and, most importantly of all, to substantially increase condom use. According to the authors, 41 percent of men and 42.5 percent of women reported never having used condoms. The online preview of the article is at http://www.aidsonline.com.

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