Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

Lancet. 2004 Feb 7;363(9407):482-8. doi: 10.1016/S0140-6736(04)15497-4.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara / epidemiology
  • Age Distribution
  • Child
  • Child, Preschool
  • Equipment Contamination / prevention & control*
  • Equipment Contamination / statistics & numerical data
  • Female
  • HIV Infections / prevention & control
  • HIV Infections / transmission*
  • HIV-1* / isolation & purification
  • Humans
  • Injections / adverse effects*
  • Injections / standards
  • Injections, Intramuscular / adverse effects
  • Injections, Intramuscular / standards
  • Male
  • Middle Aged
  • Needles / standards
  • Needles / virology*
  • Prevalence
  • Sex Distribution
  • South Africa / epidemiology