Three others (Goa, Gujarat and Pondicherry, with 53m people all told) have "concentrated" epidemics, with prevalence rates of 5% or more among the high-risk groups.Admittedly, some of the statistics may overstate the problem.
As mentioned earlier, the Caribbean is the only region of the world that has a robust heterosexually-driven epidemic of subtype B. In Thailand, South Africa and Argentina, concentrated epidemics in high risk populations preceded generalized epidemics in the general public.
Although South Africa has a generalised epidemic, there are pockets in communities which demonstrate concentrated epidemics.
2008 [PDF] Evidence base for Programming for children affected by HIV and AIDS in low prevalence and concentrated epidemics.
Kenya has a declining generalized HIV epidemic with well characterized concentrated epidemics among key populations, including MSM [ 17, 18].
Intensified efforts are also needed to support countries with low HIV prevalence and concentrated epidemics to reach out to all women and children at risk of HIV.
Concentrated epidemics amongst HRGs require an integrated service approach for HIV prevention efforts [ 4- 6].
"We talk about generalized epidemics and concentrated epidemics," said Dr. Kevin M. De Cock, director of global health at the Centers for Disease Control and Prevention in Atlanta.
The concentrated epidemics are driven by unprotected sex between sex workers and their clients and by injecting drug use with contaminated injecting equipment.
Programs aimed at reducing HIV and STIs among FSWs are thought to be cost-effective since they reduce HIV transmission from high-risk groups to the general population in areas with concentrated epidemics [9], [10].
The potential impact of even a moderate-efficacy vaccine as indicated in this study can also provide a powerful argument for the relevance of continued investment in research and development towards a vaccine as it presents evidence of how efforts to control HIV would dramatically benefit from it, even in the context of concentrated epidemics.
