Preventing HIV in young people in Africa: time to cut the Gordian knot?
In his editorial commenting on the Stepping Stones HIV prevention
program for young people in South Africa (1), Hayes confesses that “At
first sight the greatest puzzle is how the intervention moderately reduced
HSV-2 but had little impact on HIV…” (2). In fact, this puzzling finding
remains on second sight, for neither the South African researchers nor
Hayes consider a crucial difference between HSV-2, a sexually transmitted,
and HIV, a sexually transmissible, infection (viz., one not uncommonly
transmitted in non-sexual ways). HSV-2 is entirely spread by behaviors
covered by their intervention, but this is not necessarily the case for
HIV transmission. Since blood exposures were not assessed in the Stepping
Stones study, both researchers and readers are condemned to speculation
about this puzzling anomaly. To resolve this issue, why not cut the
Gordian knot and control for a broad array of potential blood exposures,
particularly in studies conducted in countries where exposures to
contaminated sharps may be common (3)?
1. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, et al.
Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual
behaviour in rural South Africa: cluster randomized controlled trial. BMJ
2008; 337: a506.
2. Hayes R. Prevention of HIV in young people in Africa
(Editorial). BMJ 2008; 337: a743
3. Hutin YJF, Hauri AM, Armstrong GL. Use of injections in
healthcare settings worldwide, 2000: literature review and regional
estimates. BMJ 2003; 327: 1075.
Competing interests: No competing interests