Control of sexually transmitted diseases for HIV-1 prevention: Understanding the implications of the Mwanza and Rakai trials

Heiner Grosskurth, Ronald Gray, Richard Hayes, David Mabey, Maria Wawer

Research output: Contribution to journalReview article

Abstract

Two randomised controlled trials of sexually transmitted disease (STD) treatment for the prevention of HIV-1 infection, in Mwanza, Tanzania, and Rakai, Uganda, unexpectedly produced contrasting results. A decrease in population HIV-1 incidence was associated with improved STD case management in Mwanza, but was not associated with STD mass treatment in Rakai. Some reductions in curable STDs were seen in both studies. These trials tested different interventions in different HIV-1 epidemic settings and used different evaluation methods; the divergent results may be complementary rather than contradictory. Possible explanations include: differences in stage of the HIV-1 epidemic, which can influence exposure to HIV-1 and the distribution of viral load in the infected population; potential differences in the prevalence of incurable STDs (such as genital herpes); perhaps greater importance of symptomatic than symptomless STDs for HIV-1 transmission; and possibly greater effectiveness of continuously available services than of intermittent mass treatment to control rapid STD reinfection. Implications of the trials for policy and future research agenda are discussed.

Original languageEnglish (US)
Pages (from-to)1981-1987
Number of pages7
JournalLancet
Volume355
Issue number9219
DOIs
StatePublished - Jun 3 2000

ASJC Scopus subject areas

  • Medicine(all)

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