Understanding HIV transmission for an improved AIDS response in West Africa
03 December 2008
On the opening day of International Conference on AIDS and STIs in Africa (ICASA), taking place in Senegal under the theme “Africa’s Response: Face the facts,” the World Bank launched a new report exploring the character of the HIV epidemics and responses in countries in West Africa.
The “West Africa HIV/AIDS epidemiology and response synthesis” is a review and analysis of surveillance and research data in 15 West African countries: Benin, Burkina Faso, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, Togo, Cape Verde, The Gambia, Guinea Bissau, Liberia, and Sierra Leone.
Aiming to gain an improved understanding of HIV transmission dynamics in this sub-region, the paper focuses on the degree to which epidemics in each country are concentrated or generalized, and the implications that this has for effective prevention strategies. The report argues that more prevention focus is needed on the specific groups in which HIV transmission is concentrated, including female sex workers and men who have sex with men.
The new publication highlights a need for better understanding of the complex nature of transactional sex in West Africa. Many women involved in commercial sex do not self-identify as sex workers and have other occupations as well. The boundaries between commercial and non-commercial sex are blurred and it is difficult to have an idea of the proportion of men having commercial sex due to substantial under-reporting.
The importance of men who have sex with men (MSM) in the HIV epidemic in West Africa is being increasingly recognized. High proportions of MSM are also married and/or have sex with other women with very low rates of condom use, acting as a bridge for HIV between MSM and women.
“Know your epidemic. Know your response”
The paper was written as part of the work programme by the World Bank’s Global AIDS Monitoring and Evaluation Team (GAMET) to support countries to “know your epidemic, know your response” so that interventions are carefully chosen and prioritized based on a careful characterization of each country’s epidemic.
Understanding the behaviors that are giving rise to most new infections is a crucial first step to being able to develop a results-focused, evidence-based response that will be effective in preventing new infections. In turn this will improve resource allocation, all the more appropriate when global economic outlook may impact AIDS response.
The work was carried out in partnership between the World Bank and UNAIDS and with the collaboration of the National AIDS Councils and AIDS programmes of the countries.