The Concurrency Hypothesis in Sub-Saharan Africa: Convincing Empirical Evidence is Still Lacking. Response to Mah and Halperin, Epstein, and Morris
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We would like to thank the authors for their comments on our article that questioned the amount and quality of the evidence to support the hypothesis that concurrent partnerships are a key driver of the HIV epidemics in Africa . All three letters agree with us that we “raise some valid concerns” that the “evidence for this link is still somewhat limited”  and that further research is needed [3, 11]. We note further that the three letters were from the most vocal concurrency advocates, and do not necessarily represent mainstream opinion about the current state of knowledge on this important topic .
Although the purpose of our article was not to provide an extensive and complete literature review but rather to comment on Mah and Halperin’s work (which they themselves called “a selective review” ), Epstein faults us for displaying “a highly selective reading” of the literature . Repeating the points made by Mah and Halperin in favor of the concurrency hypothesis would have
- Abu-Raddad LJ, Longini IM. No HIV stage is dominant in driving the HIV epidemic in sub-Saharan Africa. AIDS. 2008;22(9):1055–61. CrossRef
- Caraël M. Sexual behaviour. In: Cleland JG, Ferry B, editors. Sexual behaviour and AIDS in the developing world. London: Taylor & Francis, World Health Organization; 1995.
- Epstein H. The mathematics of concurrent partnerships in Africa’s HIV epidemics: a response to Lurie and Rosenthal. AIDS Behav. Epub ahead of print. 2009. doi:10.1007/s10461-009-9627-x.
- Halperin D, Epstein H. Concurrent sexual partnerships help to explain Africa’s high HIV prevalence: implications for prevention. Lancet. 2004;364(9428):4–6. CrossRef
- Hollingsworth TD, Anderson RM, Fraser C. HIV-1 transmission, by stage of infection. J Infect Dis. 2008;198(5):687–93. CrossRef
- Kelvin, L. Popular lectures and addresses, 1891–1894. Quoted in Weiner J, editor. The Beak of the Finch. New York: Alfred A. Knopf; 1994.
- Kretzschmar M, White RG, Carael M. (in press). Concurrency is more complex than it seems. AIDS. doi:10.1097/QAD.0b013e328333eb9d.
- Lurie M, Rosenthal S. Concurrent partnerships as the driver of the HIV epidemic in Sub-Saharan Africa? The evidence is limited. AIDS Behav. Epub ahead of print. 2009. doi: 10.1007/s10461-009-9853-5.
- Mah T, Halperin D. Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS Behav. Epub ahead of print. 2009. doi: 10.1007/s10461-008-9433-x.
- Mah T, Halperin D. The evidence for the role of concurrent partnerships in Africa’s HIV epidemics: a response to Lurie and Rosenthal. AIDS Behav. doi:10.1007/s10461-009-9617-z.
- Morris M. Barking up the wrong evidence tree. Comment on Lurie and Rosenthal, “Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited.” AIDS Behav. (in press).
- Morris M, Kretzschmar M. A microsimulation study of the effect of concurrent partnerships on the spread of HIV in Uganda. Math Popul Stud. 2000;8(2):109–33. CrossRef
- Pilcher CD, Tien HC, Eron JJ, Vernazza PL, Leu SY, Stewart PW, et al. Brief but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis. 2004;189(10):1785–92. CrossRef
- Rapatski BL, Suppe F, Yorke JA. HIV epidemics driven by late stage transmission. J Acquir Immune Defic Syndr. 2005;38(3):241–53.
- Reniers G, Watkins S. Polygyny and the spread of HIV in Sub Saharan Africa: a case of benign concurrency. AIDS. doi:10.1097/QAD.0b013e328333af03.
- Tanser F, Barnighausen T, McGrath N, Garnett G, Newell ML. Levels of partnership concurrency and risk of HIV acquisition in a high-prevalence, rural South African population. Paper forthcoming at EPIDEMICS2: the Second International Conference on Infectious Disease Dynamics, Athens, Greece, December 2–4, 2009. (in press).
- UNAIDS. (2007) UNAIDS response to newly published book “The Invisible Cure” by Helen Epstein. Available at: http://data.unaids.org/pub/PressStatement/2007/070611_bookresponse02_en.pdf.
- Wellings K, Collumbien M, Slaymaker E, et al. Sexual behavior in context: a global perspective. Lancet. 2006;368:1706–28. doi:10.1016/S0140-6736(06)69479-8. CrossRef
- The Concurrency Hypothesis in Sub-Saharan Africa: Convincing Empirical Evidence is Still Lacking. Response to Mah and Halperin, Epstein, and Morris
AIDS and Behavior
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