What is it about?
Sub-Saharan Africa (SSA), and even more Southern Africa, has become the continent with far more cases of HIV infection since the late eighties-early nineties. In 2023, an average 15.3% of the adult population in South Africa, Eswatini, Lesotho, Zimbabwe, Botswana, Mozambique, Namibia, Zambia, and Malawi was living with HIV. The explanation for the high number of people with HIV in those nine Southern Africa countries has long been transmission through vaginal intercourse, mainly due to sexual promiscuity. In my Opinion article, I argue that this explanation does not hold up.
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Photo by E. Diop on Unsplash
Why is it important?
Analyses of HIV sexual transmission per vaginal intercourse act show that its relevance is far less than sexual transmission per anal intercourse act. An important role for heterosexual anal intercourse in HIV transmission must no longer be overlooked. Non-sexual transmission of HIV through injections, ritual and medicinal enemas, and ritual scarification should also be better investigated.
Perspectives
To further diminish HIV incidence around the world, thorough medical histories must be obtained by every individual found to have acquired the infection to investigate the possible route of acquisition, whether sexual or non-sexual. Information about the risks of anal intercourse must be prioritized and integrated into sexual health programmes for the general population.
Professor Sandro Vento
Manash Kozybayev North Kazakhstan University
Read the Original
This page is a summary of: HIV transmission in sub-Saharan Africa: excessive focus on heterosexual vaginal intercourse, Frontiers in Public Health, September 2025, Frontiers,
DOI: 10.3389/fpubh.2025.1667141.
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