I attended a session on Tuesday about Measuring HIV Transmission Dynamics: How and Where are New Infections Occurring? One of the presentations by D. Ross focused on Using Surrogate Biological Outcomes for HIV Incidence. In his study, he compared probability of pregnancy, risk of HSV2 and HIV transmission in different relationships to see if the likelihood of HSV2 acquisition or conception were equivalent to the likelihood of HIV transmission and could thus be used as proxy indicators. One of the findings oulined that if a 17 year-old female in rural Kenya was in a relationship with a 17-year old male in rural Kenya her risk for HIV and HSV2 was significantly lower than if she was in a relationship with a 32 year-old male in rural Kenya.
While this is an incredibly interesting finding, it's implications for the programmatic setting are cause for questions. Should we develop a campaign that encourages sexual relationships with age-mates? Would that be ethical and/or would donors be accepting of such a strategy in light of this research? Ultimately, this finding simply underscores the relevance and need for campaigns focused on cross-generational sex - a topic on which PSI and other organizations are already focused. So, in full recognition that I'm harping on one specific finding of an otherwise very interesting study that has implications on the public health community's ability to adequately carry-out HIV surveillance, from a purely programmatic messaging perspective I'm not sure that we've REALLY learned anything that groundbreaking and new.