Explore the vast range of titles available.

The role of concurrent sexual partnerships is increasingly recognized as important for the transmission of sexually transmitted infections, particularly of heterosexual HIV transmission in Africa. Modeling and empirical evidence suggest that concurrent partnerships—compared to serial partnerships—can increase the size of an HIV epidemic, the speed at which it infects a population, and its persistence within a population. This selective review of the published and unpublished literature on concurrent partnerships examines various definitions and strategies for measuring concurrency, the prevalence of concurrency from both empirical and modeling studies, the biological plausibility of concurrency, and the social and cultural underpinnings of concurrency in southern Africa.

Background Strategies to control coronavirus 2019 disease (COVID-19) have often been based on preliminary and limited data and have tended to be slow to evolve as new evidence emerges. Yet knowledge about COVID-19 has grown exponentially, and the expanding rollout of vaccines presents further opportunity to reassess the response to the pandemic more broadly. Main text We review the latest evidence concerning 10 key COVID-19 policy and strategic areas, specifically addressing: 1) the expansion of equitable vaccine distribution, 2) the need to ease restrictions as hospitalization and mortality rates eventually fall, 3) the advantages of emphasizing educational and harm reduction approaches over coercive and punitive measures, 4) the need to encourage outdoor activities, 5) the imperative to reopen schools, 6) the far-reaching and long-term economic and psychosocial consequences of sustained lockdowns, 7) the excessive focus on surface disinfection and other ineffective measures, 8) the importance of reassessing testing policies and practices, 9) the need for increasing access to outpatient therapies and prophylactics, and 10) the necessity to better prepare for future pandemics. Conclusions While remarkably effective vaccines have engendered great hope, some widely held assumptions underlying current policy approaches call for an evidence-based reassessment. COVID-19 will require ongoing mitigation for the foreseeable future as it transforms from a pandemic into an endemic infection, but maintaining a constant state of emergency is not viable. A more realistic public health approach is to adjust current mitigation goals to be more data-driven and to minimize unintended harms associated with unfocused or ineffective control efforts. Based on the latest evidence, we therefore present recommendations for refining 10 key policy areas, and for applying lessons learned from COVID-19 to prevent and prepare for future pandemics.

According to nationally representative surveys, between 2005 and 2011, infant mortality decreased by 23%, falling from 77 to 59 deaths per 1000 births, and under-5 mortality declined by 28%, from 123 to 88 per 1000 births.13 Maternal mortality is still a substantial problem, but is being increasingly prioritised in policies and public campaigns, and has also begun to decline in recent years.13 Finally, adult HIV prevalence in Ethiopia remains at slighty more than 1%.13,14 Family planning has probably played an important part in some of these broad health improvements.

The earlier successes in Thailand and Uganda may not be fully relevant to the severely affected countries of southern Africa. * We conducted an extensive multi-disciplinary synthesis of the available data on the causes of the remarkable HIV decline that has occurred in Zimbabwe (29% estimated adult prevalence in 1997 to 16% in 2007), in the context of severe social, political, and economic disruption. * The behavioral changes associated with HIV reduction--mainly reductions in extramarital, commercial, and casual sexual relations, and associated reductions in partner concurrency--appear to have been stimulated primarily by increased awareness of AIDS deaths and secondarily by the country's economic deterioration. [...]DHS data on various potential proximal and contextual determinants of behavior change for Zimbabwe were compared with similar data for seven other southern African countries to identify distinctive patterns that might help to explain the earlier and faster HIV decline observed in Zimbabwe (Figures 2, S1).

Background Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves. Discussion We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used. Summary Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.

The use of face masks has been widely promoted and at times mandated to prevent coronavirus disease 2019 (COVID-19). The 2023 publication of an updated Cochrane review on mask effectiveness for respiratory viruses as well as the unfolding epidemiology of COVID-19 underscore the need for an unbiased assessment of the current scientific evidence. It appears that the widespread promotion, adoption, and mandating of masking for COVID-19 were based not primarily on the strength of evidence for effectiveness but more on the imperative of decision-makers to act in the face of a novel public health emergency, with seemingly few good alternatives. Randomized clinical trials of masking for prevention of COVID-19 and other respiratory viruses have so far shown no evidence of benefit (with the possible exception of continuous use of N95 respirators by hospital workers). Observational studies provide lower-quality evidence and do not convincingly demonstrate benefit from masking or mask mandates. Unless robust new evidence emerges showing the effectiveness of masks in reducing infection or transmission risks in either trials or real-world conditions, mandates are not warranted for future epidemics of respiratory viral infections.

[...] where, in broad categories, are most new infections occurring: in sex workers, men who have sex with men, or injecting drug users (and their sexual partners), or through multiple concurrent partnerships in the general population? second, although mathematical modelling of incident infections may be helpful, such models are in their infancy, make several major assumptions, and require better data than are generally available. In Uganda, the intensive focus on zero grazing (ie, partner reduction) two decades ago/ which helped lead to a dramatic reduction in multiple partnerships and a historically unprecedented decline in HIV prevalence, has in recent years been replaced by emphasis on other approaches, including social marketing of condoms and abstinence, and HIV incidence may now be increasing again, as are multiple partnerships.8,12,18,46,47 To conclude: first, the move to \"know your epidemic, know your response\" is welcome, but must not become overcomplicated-broad brushstrokes are sufficient for decisive, intelligent action.

Response to: Lurie M.N. and Rosenthal S. 2009. \"Concurrent partnerships as a driver of the HIV epidemic in Sub-Saharan Africa? The evidence is limited.\". Adapted from the source document.

What might account for this pervasive discrepancy? The strong association between lack of male circumcision and HIV risk8-10 helps explain the 4-5-fold difference in HIV rates between southern and western Africa discussed by Asamoah-Odei and colleagues. However, that association does not explain why HIV has spread so much more extensively in southern Africa than in India, or in Europe, where circumcision is similarly uncommon. Although sexual cultures do vary from region to region,11 the differences are not so obvious. Demographic surveys and other studies suggest that, on average, African men typically do not have more sexual partners than men elsewhere. For example, a comparative study of sexual behaviour found that men in Thailand and Rio de Janeiro were more likely to report five or more casual sexual partners in the previous year than were men in Tanzania, Kenya, Lesotho, or Lusaka, Zambia. And very few women in any of these countries reported five or more partners a year.12 Men and women in Africa report roughly similar, if not fewer, numbers of lifetime partners than do heterosexuals in many western countries.13-15 Of increasing interest to epidemiologists is the observation that in Africa men and women often have more than one-typically two or perhaps three-concurrent partnerships that can overlap for months or years (figure). This pattern differs from that of the serial monogamy more common in the west, or the one-off casual and commercial sexual encounters that occur everywhere.

There has been considerable interest in understanding what may have led to Uganda's dramatic decline in HIV prevalence, one of the world's earliest and most compelling AIDS prevention successes. Survey and other data suggest that a decline in multi-partner sexual behavior is the behavioral change most likely associated with HIV decline. It appears that behavior change programs, particularly involving extensive promotion of \"zero grazing\" (faithfulness and partner reduction), largely developed by the Ugandan government and local NGOs including faith-based, women's, people-living-with-AIDS and other community-based groups, contributed to the early declines in casual/multiple sexual partnerships and HIV incidence and, along with other factors including condom use, to the subsequent sharp decline in HIV prevalence. Yet the debate over \"what happened in Uganda\" continues, often involving divisive abstinence-versus-condoms rhetoric, which appears more related to the culture wars in the USA than to African social reality.