Jun 22, 2010
The UN AIDS programme estimates that in excess of 5.7 million people are living with HIV in South Africa with around 3.2 million being women and 280,000 children up to the age of 14 years.
The prevalence of HIV in the general population in South Africa is over 18% compared with less than 0.2% in the UK.
There is a significant difference in HIV prevalence in South Africa between different provinces with KwaZulu-Natal having a rate of above 40% to approximately 15% in the Western Cape (Cape Town).
At Freedomhealth we have seen a large number of men who have returned recently from South Africa who have had unprotected sex with female commercial sex workers. This presents a significant hazard to the men themselves and their female partners they might return to. Significant numbers of these males have required either early intervention here in the UK with Post Exposure Prophylaxis (PEP) for HIV or have needed continuation of PEP already commenced in South Africa.
UNAIDS/WHO data (which is subject to time lag in terms of collection and reporting) suggests that in the major urban areas of South Africa the prevalence of HIV infections in female sex workers is in excess of 50%.
The generally stated and averaged risk of heterosexual transfer of HIV during heterosexual vaginal sex is approximately 0.1% or 1 in 1000 to 1 in 1200 "chance". However, this is an average and will vary quite markedly depending on both the "source" ie the infected patient's status and also the health of the non-infected participant. The figure is also taken from data obtained from industrialised Western countries irrespective of use of antiretrovirals.
We know that the rate of bacterial STD's in South Africa especially in the sex worker communities is very high indeed. We know also that other sexually transmitted diseases will facilitate the transfer of HIV. Sexual violence, poverty, underlying nutritional and health status and simultaneous presence of other, especially genitally ulcerating STD's will increase the chances of HIV transfer. Ulcerating genital disease caused by STD's such as herpes, syphilis, gonorrhoea, chancroid will increase the chances of transfer by up to approximately 6 times.
HIV transfer rates are up to 10 times higher in the early and late phase of HIV disease when the HIV viral load - the amount of virus in the blood stream and thus probably in genital secretions is markedly increased. In the quiet, asymptomatic phase a few months after infection, viral load will fall and so will potential infectivity.
Consequently, men having unprotected vaginal or anal sex with female sex workers in South Africa especially in some of the very high prevalence urban areas will expose themselves to an escalating lottery of risk depending on the circumstances of the women with whom they have sex. Uncontrolled HIV with high viral load, together with acquisition of STD's resulting in genital ulceration will expose them to an extremely high risk of contracting HIV. Unfortunately with upwards of 50,000 UK supporters in South Africa for the World Cup it is a certainty that some will return with a new HIV infection.
Condoms remain a thoroughly effective way of preventing HIV transfer and indeed are the only way to prevent transfer. The problem is not intact condom failure but failure to wear them in the first place and occasionally rupture or tear of the condom itself.
Men exposed to unprotected sex whilst in South Africa should seek medical attention whilst they are present there or return home for consideration of Post Exposure Prophylaxis and also screening for STD's and STI's prior to resuming sex with their regular partners.