HETEROSEXUAL TRANSMISSION OF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 (HIV) - INTERACTIONS OF CONVENTIONAL SEXUALLY-TRANSMITTED DISEASES, HORMONAL CONTRACEPTION AND HIV-1

The interactions between HIV-1 and other viral sexually transmitted in fections (STI) are complex, The presence of ulcerative and nonulcerati ve STD increase susceptibility of exposed individuals to HIV-1 infecti on by several folds. In HIV-1 infected individuals, STD increase genit al tract shedding of HIV-1 and enhance the infectivity of these indivi duals. STD have also recently been shown to increase plasma viremia ei ther directly or through altering the cytokine milieu, which may both increase infectivity and result in more rapid HIV-1 disease progressio n. HIV-1 infection in turn has effects on susceptibility to other STD as well as increasing the serverity of some infections and possibly re ducing the response to antimicrobial therapy. In addition, other poten tial risk factors for sexual transmission of HIV-1, such as hormonal c ontraception in women and lack of circumcision in men, may operate par tly through effects on enhancing susceptibility to STD. The mutual enh ancement of transmission of HIV-1 and other STD that has fueled HIV-1 epidemics worldwide, offers the opportunity for intervention. The effe ctiveness of this approach has recently been demonstrated in a trial i n Mwanza, Tanzania, where provision of effective treatment for STD res ulted in a 40% decline in HIV-1 incidence, The implementation of effec tive STD management may do much to slow the spread of HIV-1.