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March 2003 HIV/AIDS Public Health Journal Club
by Judith King. HIVAN Media Office
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Professor Willem Sturm from the University of KwaZulu-Natal's Department of Medical Microbiology was the guest presenter at the March 2003 session of the monthly HIV/AIDS Public Health Journal Club, held at the University of KwaZulu-Natal's Nelson R Mandela School of Medicine. His talk was entitled: "The association between HIV infection and other sexually transmitted infections".
By way of introduction, Professor Jerry Coovadia addressed the topic of sexually transmitted infections (STIs) in relation to the epidemic, explaining that, given the complex matrix of factors propelling the spread of HIV, there is no single answer as to why HIV/AIDS is so virulent in South Africa. However, STIs are widely recognised as highly important and very common clinical risk conditions for the spread of HIV in particular, and are therefore the subject of intense biomedical and behavioural research.
Professor Sturm began by saying that the impact of HIV infection on clinical presentations and responses to treatment of STIs other than HIV, as well as their syndromic management, formed the basis of his research. He noted that clinical diagnoses were problematic, in that there was no uniformly typical set of symptoms indicating close association between STIs and HIV, so that meticulous surveillance was essential in order to ascertain the prevalence of relevant pathogens and the possible links between them.
He then took the audience through a comprehensive series of studies conducted at the Hlabisa site and modelled on an STD/HIV co-factor hypothesis of: "STDs enhance HIV transmission, therefore if STDs are reduced, HIV transmission can be reduced ". These studies attempted to identify acquisition and transmission factors, the efficacy of syndromic treatment management and details of geno-typing testing methods relating to re-infection.
One experiment highlighted the importance of partner notification; however, Professor Sturm observed that it was extremely difficult to ensure treatment for sexual partners in rural KwaZulu-Natal, for, in the case of afflicted women, if they disclosed their STD status, they ran the risk of being physically assaulted by their partners. There was epidemiological and biological evidence confirming that STD conditions in HIV-positive patients do enhance STD infections in HIV-negative partners; however, it was less clear as to whether these infections enhance HIV transmission.
Prof Sturm referred to three trials conducted in East Africa (Mwanza, Tanzania 1991 - 95; Rakai, Uganda 1994 - 98 and Masaka, Uganda 1995 - 2001) and noted that the evidence yielded by these studies was contradictory, possibly because of the variations of factors they involved, e.g. different populations and interventions, different levels of maturity of the epidemic across the sites, sexual risk behaviour factors, etc., or because of random error.
To download the full presentation, which details the hypotheses, results, discussion and conclusions of all the studies referred to, please click on the link in the right-hand column, and open the PowerPoint document in WinZip. |
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