A gruesome read at times, not for the faint of heart.

• Africa will suffer the worst from AIDS epidemics.
• History: don’t really know where AIDS comes from, or when [most recent evidence suggests that it goes back to 17th Century Africa].  It was recognized clinically in 1981.
• A plurality of AIDS cases are in Africa, relative to world (~1/3). Infections spread heterogeneously through Sub-Saharan region, up to 1 in 3 adults in some areas. Lower in rural vs. urban areas. Some population groups worse off: 20-40 year olds, people with STDs and TB, truck drivers/prostitutes/military occupations. But infection is spreading to general population.
• Problem: much of African population is young, at higher risk, as they have more sex partners.
• Are different kinds of HIV: HIV-1 and HIV-2. HIV-2 is more prevalent in West Africa, and has lower pathogenic potential than HIV-1.  Latent longer, more rarely transmitted from mother to infant.
• Distribution of HIV-2 is largely in former Portuguese colonies, showing that culture plays a role in HIV spread.
• But HIV-1 is spreading even in areas where HIV-2 is prevalent at a faster rate than HIV-2.
• Risk factors in sexual transmission: no. of sex partners, frequency of unprotected sex, commercial sex, having another STD, lack of male circumcision, anal intercourse.
• STDs are very prevalent in Africa in general, and, via ulceration, may increase potential spread of HIV. Working against STDs in general will aid in lowering HIV infection rates. Also, STDs cause infertility, and may cause woman to take multiple partners to achieve pregnancy and avoid social stigma.
• See p. 91 for equation of reproductive rate of transmission for an STD. Includes odds of transmission for each sex act, duration of infectiousness per individual, and no. of new sex partners per year.
• High prevalence of STDs, low rates of male circumcision, high rates of prostitution, heterogeneous sexual mixing, low rates of condom use, and long duration of the HIV/AIDS epidemic mix to give Africa its high infection rate relative to the world at large.
• Due to severity of epidemic, would need a very powerful vaccine, high vaccination rates to slow AIDS in some populations.
• High rate of perinatal transmission in Africa (mother to child).  Due in part to environment, breast feeding, conditions of pregnancy/delivery.
• Low rate of transmission by blood contact (parenteral) - less than 10 percent. Some problem in inadequate blood bank screening, ritual scarification. Little issue with IV drug use.
• Authors recommend much more research, especially on behavior. Need to recognize there are many heterogeneous African populations, and not overgeneralize. Should combine sociodemographic study with biological studies.
• Must expand monitoring of prevalence/incidence of STDs and HIV.