During the past year, a group has argued that unsafe injections are a major if not the main mode of HIV-1 transmission in sub-Saharan Africa. We review the main arguments used to question the epidemiological interpretations on the lead role of unsafe sex in HIV-1 transmission, and conclude there is no compelling evidence that unsafe injections are a predominant mode of HIV-1 transmission in sub-Saharan Africa. Conversely, though there is a clear need to eliminate all unsafe injections, epidemiological evidence indicates that sexual transmission continues to be by far the major mode of spread of HIV-1 in the region. Increased efforts are needed to reduce sexual transmission of HIV-1.
Schmid, G.P.; Buve, A.; Mugyenyi, P.; Garnett, G.P.; Hayes, R.J.; Williams, B.G.; Calleja, J.G.; de Cock, K.M.; Whitworth, J.A.; Kapiga, S.H.; Ghys, P.D.; Hankins, C.; Zaba, B.; Heimer, R.; Boerma, J.T. Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections. Lancet (2004) 363 (9407) 482-488. [DOI: 10.1016/S0140-6736(04)15497-4]