HIV This Week

Stover J, Fidzani B, Molomo BC, Moeti T, Musuka G. Estimated HIV trends and program effects in Botswana. PLoS ONE. 2008;3(11):e3729.

This study uses surveillance, survey, and programme data to estimate past trends and current levels of HIV in Botswana and the effects of treatment and prevention programmes. Data from sentinel surveillance at antenatal clinics and a national population survey were used to estimate the trend of adult HIV prevalence from 1980 to 2007. Using the prevalence trend, Stover and colleagues estimated the number of new adult infections, the transmission from mothers to children, the need for treatment and the effects of antiretroviral therapy and adult and child deaths. Prevalence has declined slowly in urban areas since 2000 and has remained stable in rural areas. National prevalence is estimated at 26% (25-27%) in 2007. About 330,000 (318,000-335,000) people are infected with HIV including 20,000 children. The number of new adult infections has been stable for several years at about 20,000 annually (12,000-26,000). The number of new child infections has declined from 4600 in 1999 to about 890 (810-980) today due to nearly complete coverage of an effective programme to prevent mother-to-child transmission (PMTCT). The annual number of adult deaths has declined from a peak of over 15,500 in 2003 to under 7400 (5000-11,000) today due to coverage of antiretroviral therapy that reaches over 80% in need. The need for antiretroviral therapy will increase by 60% by 2016. Botswana’s prevention of mother-to-child transmission and treatment programmes have achieved significant results in preventing new child infections and deaths among adults and children. The number of new adult infections continues at a high level. More effective prevention efforts are urgently needed.

Editors’ note: Botswana’s prevention of mother-to-child transmission programme reaches over 90% of HIV-positive women and coverage of people in need of antiretroviral treatment has increased to over 80%. Although Botswana has succeeded in stabilizing its HIV epidemic, it remains at a very high level. An estimated 24,000 people join the ranks of the treatment–eligible each year because of the high number of infections in the past. HIV prevention strategies need rethinking, particularly with respect to the continuing high level of partner concurrency, given that there is a seemingly stable number of 18,000 people newly infected per year today, all of whom will eventually require treatment.

Gyarmathy and colleagues assessed the prevalence of HIV and selected blood-borne and sexually transmitted infections among a convenience sample of 64 residents of Dzsumbuj, a predominantly Roma (Gypsy) neighbourhood in Budapest, Hungary. No cases of HIV were detected, while the prevalence of hepatitis B infection (anti-HBc) was 27% and syphilis prevalence was 2%. Romas (n = 50) were significantly more likely than non-Romas (n = 14) to have hepatitis A antibodies (80% vs. 43%) and less likely to be hepatitis B immunized (anti-HBs only; 6% vs. 29%). Current drug injectors (n = 13) were more likely than non-injectors (n = 51) to have antibodies against hepatitis A (85% vs. 69%) and hepatitis C (85% vs. 8%). While HIV has not been introduced in this population, risk conditions for a potentially explosive HIV epidemic are present. Health care policies should focus on expanding coverage for hepatitis A and hepatitis B immunizations, and access to HIV preventive services needs to be extended to marginalized, mostly minority populations, such as the Roma in Europe.

Editors’ note: Romas or gypsies, thought to comprise 5 to 10% of the population of Central and Eastern Europe, are a mobile, socially marginalised, hard-to-reach minority. This rapid assessment survey produced data that justify extending hepatitis A and hepatitis B immunization services as well as HIV preventive programmes to them now to improve health and block HIV from gaining a toehold in this disadvantaged population.