Establishing valid AIDS monitoring and research in countries with generalized epidemics

The authors present guidelines for valid HIV/AIDS surveillance and epidemiologic research, and for clarification of uncertainties in transmission dynamics, particularly in countries with generalized epidemics. The consensus assumption that most HIV/AIDS cases in many developing regions, particularly sub-Saharan Africa, are explained by 'heterosexual' transmission (interpreted, by default, to mean penile-vaginal intercourse) has been challenged by recent reviews demonstrating an important contribution from unsafe health care practices. Resolution of existing uncertainties about the proportions of HIV transmission accounted for by specific parenteral exposures and sexual practices (e.g., vaginal and anal intercourse, considered separately) is crucial for the design and implementation of efficacious prevention strategies. Accurate risk-factor information is the best foundation upon which people living in countries with generalized epidemics can learn to protect themselves and their families. Multimethod approaches for developing sound HIV/AIDS research are presented.