The African AIDS epidemic
The African AIDS epidemic
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DOI：
10.1038/scientificamerican0396-62
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发表时间：
1996-03-01
影响因子：
3
通讯作者：
Caldwell, P
中科院分区：
文献类型：
--
作者：
Caldwell, JC;Caldwell, P
尽管我们最初在寻找可能助长异性恋流行的原因时遇到了困难，但我们在1989年发现了一条新的线索。在疫情严重的内罗毕肯雅塔医学院工作的一个肯尼亚-肯尼亚联合医学研究小组一年前报告说，来自肯尼亚西部的卢奥移民的艾滋病发病率高于来自肯尼亚中部的基库尤人。一开始，研究人员认为卢奥族患艾滋病的风险更大，因为他们是从靠近乌干达的地区迁移过来的，研究人员认为乌干达可能是艾滋病流行的中心。但是，随着震中的想法变得越来越站不住脚，研究人员提出了另一种解释：他们推测，卢奥人面临的风险更大，因为他们不像基库尤，没有接受割礼。显然，未割包皮的罗族男子更容易患软下疳（一种以生殖器上的软疮为特征的性传播疾病）或梅毒。这些人感染艾滋病毒的风险也出乎意料地高（见第66页<艾滋病病毒感染的风险>）：在首都内罗毕，一名患有软下疳的卢奥族男子与一名艾滋病毒阳性的妓女发生过一次性关系，感染艾滋病毒的几率为50%。利用这些数据，1989年，
9lthough we were initially stymied in our search for what might be fueling the heterosexual epidemic, we found a new lead in 1989. A joint Canadian-Kenyan medical research team working at Kenyatta Medical School in Nairobi, where the epidemic is intense, had reported a year earlier that AIDS rates were higher among Luo migrants from western Kenya than among the Kikuyu from central Kenya. At ‘rst, the researchers assumed that the Luo ethnic group was at greater risk of the disease because they migrated from an area that is close to Uganda, which the researchers believed might be the epicenter of the HIV epidemic. But as the epicenter idea became less tenable, the researchers proposed an alternative explanation: they surmised that the Luo were at greater risk because, unlike the Kikuyu, they were not circumcised. Apparently, uncircumcised Luo men were more likely to have chancroid» a sexually transmitted disease characterized by soft sores on the genitals» or syphilis. These men also had an unexpectedly elevated risk of contracting HIV [see box on page 66]: in the capital city of Nairobi, a Luo man with chancroid who had sex once with an HIV-positive prostitute had a 50 percent chance of contracting the virus. Drawing on these ‘ndings, in 1989 an