However, these markers are prone to error due to role expectations, shame and/or social desirability bias and thus can be misleading. Subjective and indirect markers of self-reported sexual behavior are often used as a proxy marker in order to determine an HIV intervention’s success. However, in the evaluation of HIV intervention in low prevalence settings, its use may be limited by low incidence rates that would require large sample sizes to show differences between intervention groups. HIV incidence is the best outcome measure of HIV prevention programs. HIV seroprevalence as well as HSV-2 seroprevalence has been shown to be closely associated with sexual behavior but prevalence for HSV-2 is much higher than for HIV. Not only symptomatic HSV-2 infections with ulcerations but also latent infections without any clinical signs lead to a higher HIV susceptibility through activation of immunological mechanisms. Worldwide about 90 to 100% of HIV positive individuals are co-infected with HSV-1 and about 52 to 95% with HSV-2. If genital ulcerations are present, the HIV transmission rate is 7 to 11 times higher. Conversely, HIV acquisition is associated with HSV-2 seropositivity, and GUD is increased after HIV seroconversion. HSV-2 is also increasingly important as cause for genital ulcer disease (GUD) and as a cofactor in HIV infection. Once adolescents become sexually active, a sharp increase in prevalence of HSV-2 antibodies has been observed in various studies rising from, for example, 5% in a population-based sample of males 13–14 years of age, to 60% in males 25–29 years of age, in a study conducted in western Kenya women had higher rates of 10% and 90%, in the respective age groups. The seroprevalence of HSV-2 antibodies varies greatly by gender, age group, country, region within the country, and across subpopulations. After initial infection individuals develop antibodies that are detectable throughout life. HSV-2 is one of the most prevalent sexually transmitted infections (STI). This latent infection can be reactivated to induce recurrent disease. After initial infection the virus persists in the sensory ganglia for life. Herpes simplex virus type 2 (HSV-2) is transmitted almost exclusively sexually. This does not alter the authors adherence to all the PLOS ONE policies on sharing data and materials. There are no further patents, products in development or marketed products to declare. provided the ELISA as well as the POC kits free of charge for this study on demand. ( ) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: Focus Diagnostics Inc. generously provided the ELISA as well as the POC kits free of charge for this study. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedĭata Availability: All relevant data are within the paper and its Supporting Information files.įunding: Funding was provided by The William and Flora Hewlett Foundation (Grant No. Received: DecemAccepted: ApPublished: May 26, 2015Ĭopyright: © 2015 Behling et al. PLoS ONE 10(5):Īcademic Editor: Richard Thompson, University of Cincinnati School of Medicine, UNITED STATES Citation: Behling J, Chan AK, Zeh C, Nekesa C, Heinzerling L (2015) Evaluating HIV Prevention Programs: Herpes Simplex Virus Type 2 Antibodies as Biomarker for Sexual Risk Behavior in Young Adults in Resource-Poor Countries.
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