Antibody to herpes simplex virus type 2 as a marker of sexual risk behavior in rural Tanzania. J Infect Dis

London School of Hygiene, Central Public Health Laboratory, London, United Kingdom.
The Journal of Infectious Diseases (Impact Factor: 5.78). 02/1999; 179(1):16-24. DOI: 10.1086/314555
Source: PubMed

ABSTRACT A serosurvey was conducted in a random sample of 259 women and 231 men in 12 rural communities in Mwanza Region, Tanzania, using a type-specific ELISA for Herpes simplex virus type 2 (HSV-2) infection. Seroprevalence rose steeply with age to approximately 75% in women >=25 years old and 60% in men >=30. After adjusting for age and residence, HSV-2 prevalence was higher in women who were married, in a polygamous marriage, Treponema pallidum hemagglutination assay (TPHA)-positive, had more lifetime sex partners, or who had not traveled. Prevalence was higher in men who were married, had lived elsewhere, had more lifetime partners, had used condoms, or were TPHA-positive. HSV-2 infection was significantly associated with recent history of genital ulcer. The association between HSV-2 infection and lifetime sex partners was strongest in those <25 years old in both sexes. This association supports the use of HSV-2 serology as a marker of risk behavior in this population, particularly among young people.

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    • "The limitations of self-reported sexual behavior data (Catania et al., 1990; Cleland et al., 2004; Helleringer et al., 2011; Morris, 2004; Obasi et al., 1999; Pisani et al., 2003), could be a key reason for the challenges encountered in these analyses. Our analysis provided a contextual support of a remarkable reduction in sexual risk behavior, but through an indirect approach rather than direct empirical data. "
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    ABSTRACT: HIV prevalence is decreasing in much of sub-Saharan Africa (SSA), but the drivers of the decline are subject to much dispute. Using mathematical modeling as a tool for hypothesis generation, we demonstrate how the hypothesis that the drop in prevalence reflects declines in sexual risk behavior is self-consistent. We characterize these potential declines in terms of their scale, duration, and timing, and theorize on how small changes in sexual behavior at the individual-level could have driven large declines in HIV prevalence.
    Epidemics 09/2014; 8:9–17. DOI:10.1016/j.epidem.2014.06.001 · 2.38 Impact Factor
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    • "It is almost exclusively sexually transmitted (Nahmias et al., 1990). HSV-2 antibodies have therefore been used as a surrogate marker for assessing risky sexual behavior (Nahmias et al., 1990; Obasi et al., 1999). However, presence of HSV-2 antibodies is limited in identifying recent change in sexual behavior due to their lifelong production. "
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    • "The use of age cohorts will be critical to study the nature of HSV-2 prevalence in MENA. Rates of HSV-2 prevalence often change most rapidly among adolescents and young adults, suggesting that HSV-2 can be used to gauge recent changes in risk behavior among young age cohorts (Obasi et al., 1999; Slomka, 1996; van de Laar et al., 2001; Xu et al., 2006). MENA is characterized by a massive youth bulge. "
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    ABSTRACT: HIV prevalence is low in the Middle East and North Africa (MENA) region, though the risk or potential for further spread in the future is not well understood. Behavioral surveys are limited in this region and when available have serious limitations in assessing the risk of HIV acquisition. We demonstrate the potential use of herpes simplex virus-2 (HSV-2) seroprevalence as a marker for HIV risk within MENA. We designed a mathematical model to assess whether HSV-2 prevalence can be predictive of future HIV spread. We also conducted a systematic literature review of HSV-2 seroprevalence studies within MENA. We found that HSV-2 prevalence data are rather limited in this region. Prevalence is typically low among the general population but high in established core groups prone to sexually transmitted infections such as men who have sex with men and female sex workers. Our model predicts that if HSV-2 prevalence is low and stable, then the risk of future HIV epidemics is low. However, expanding or high HSV-2 prevalence (greater than about 20%), implies a risk for a considerable HIV epidemic. Based on available HSV-2 prevalence data, it is not likely that the general population in MENA is experiencing or will experience such a considerable HIV epidemic. Nevertheless, the risk for concentrated HIV epidemics among several high-risk core groups is present. HSV-2 prevalence surveys provide a useful mechanism for identifying and corroborating populations at risk for HIV within MENA. HSV-2 serology offers an effective tool for probing hidden sexual risk behaviors in a region where quality behavioral data are limited.
    12/2010; 2(4):173-82. DOI:10.1016/j.epidem.2010.08.003
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