Intended for healthcare professionals

Clinical Review Regular review

Reducing heterosexual transmission of HIV in poor countries

BMJ 2002; 324 doi: (Published 26 January 2002) Cite this as: BMJ 2002;324:207
  1. Peter R Lamptey, president, FHI AIDS Institute (
  1. Family Health International, 2101 Wilson Boulevard, Suite 700, Arlington, VA 22201, USA

    The HIV/AIDS pandemic has devastated many countries, reversing national development, widening the gap between rich and poor people, and pushing already stigmatised groups closer to the margins of society.1 It has killed millions of people, decimated families and communities, and adversely affected the lives of hundreds of millions. AIDS stands to kill more than half the young adults in the most severely affected countries.1

    By the end of 2001 an estimated 65 million people worldwide had been infected with HIV—25 million had died and 40 million were living with HIV or AIDS, most of whom have no access to the lifesaving drugs available in industrialised countries.1 Countries in sub-Saharan Africa and South and South East Asia are the worst affected (fig 1).

    Fig 1.

    Global distribution of adults and children living with HIV or AIDS at end of 2001

    The pandemic continues its relentless spread—about 14 000 people are infected each day. This article describes the impact on health and the economic and social impact of the HIV/AIDS pandemic in poor countries, discusses the many factors that promote the heterosexual transmission of HIV, highlights successes around the world in preventing infection, and outlines some of the challenges for the future.

    Summary points

    Almost all (95%) of new infections of HIV are in the world's poor countries

    Without access to antiretroviral drugs, most of the 40 million people currently living with HIV will die

    Heterosexual transmission is responsible for most HIV infections in poor countries

    Programmes to change behaviour and promote condoms and treatment of sexually transmitted infections are effective in preventing the spread of HIV

    Large scale prevention efforts have been successful in only a few countries, mainly because of inadequate resources and lack of international commitment

    Antiretroviral drugs reduce viral load in blood and consequently in genital fluids and …

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