Cover -- Half-title -- Title -- Copyright -- Dedication -- Contents -- Contributors -- Foreword: Peter Piot -- Foreword: Nelson R Mandela -- Acknowledgements -- SECTION 1 Birth of a rapidly growing epidemic -- CHAPTER 1 Introduction -- AIDS epidemic first identified in USA -- Discovery of HIV -- AIDS in South Africa -- South Africa's response to the AIDS epidemic -- Bibliography -- CHAPTER 2 Overview of the book -- Birth of a rapidly growing epidemic -- The virus, the human host and their interactions -- Risk factors and prevention strategies -- Focal groups for understanding the HIV epidemic -- Impact of AIDS -- Treating AIDS -- What does the future hold? -- CHAPTER 3 HIV infection in South Africa: the evolving epidemic -- Transmission dynamics, prevalence and incidence rates -- Sources of data on HIV infection in South Africa -- Antenatal clinic (ANC) surveillance -- National, annual, anonymous, antenatal clinic surveys -- Annual anonymous antenatal clinic surveys in rural KwaZulu-Natal -- Population-based surveys -- Population-based surveys in rural KwaZulu-Natal -- The HSRC national population-based household surveys -- The Carletonville/urban population survey -- Other surveys -- Sex workers and clients at truck-stops in KwaZulu-Natal -- HIV infection in South Africa -- Geographical distribution -- Age differences in HIV prevalence -- Age and gender differences -- Racial differences in HIV prevalence -- Migration and its effect on other sexually transmitted infections -- Morbidity and mortality -- Conclusion -- Bibliography -- CHAPTER 4 HIV incidence rates in South Africa -- Incidence estimates for South Africa -- Direct estimates of HIV incidence -- Female sex workers in KwaZulu-Natal between 1996 and 1999 -- Young men in Orange Farm, Gauteng, between 2002 and 2004 -- Indirect estimates of HIV incidence.

Incidence rates estimated for South Africa -- Incidence rate estimates in rural KwaZulu-Natal -- Estimated incidence rates by gender and age in an urban community in Gauteng -- Conclusion -- Bibliography -- SECTION 2 The virus, the human host and their interactions -- CHAPTER 5 Viral structure, replication, tropism, pathogenesis and natural history -- Viral structure -- Viral replication -- Viral targets -- Co-receptors for HIV-1 entry -- Targeting viral entry -- Heterosexual transmission of HIV -- Natural history and viral set-point -- Humoral immunity to HIV -- Bibliography -- CHAPTER 6 HIV diagnostics -- History of HIV testing -- The diagnosis of HIV infection -- Why test for HIV? -- What to test -- HIV testing technology -- Rapid testing -- Where to use which type of diagnostic technology -- Diagnosing HIV infection in adults -- Population serosurveillance -- Interpretation of results -- Participants in HIV vaccine trials -- Detection of recent infection in adults: Primary HIV infection (PHI) and incident cases -- Diagnosis of mother-to-child (MTCT) transmission of HIV -- Diagnosis of infection in the mother -- Diagnosis of HIV infection in the infant -- Monitoring disease progression and responses to antiretroviral therapy -- Monitoring quality of testing -- Bibliography -- CHAPTER 7 HIV-1 genetic diversity -- HIV classification and diversity -- Mechanisms of HIV diversification -- The origin of HIV -- Subtype distribution in Africa -- Tracking the spread of HIV to South Africa -- Implications of the extreme diversity of HIV -- Bibliography -- CHAPTER 8 Cellular immunity in HIV: a synthesis of responses to preserve self -- Part 1: The immune response -- Anatomical arrangement of the immune system -- Cells of the immune system -- Cytokines and Th1- and Th2-profiles -- Antigens, epitopes and antigen presentation -- The T-cell receptor.

Major histocompatibility complex (MHC) -- HLA supertypes -- The T-cell response and clonal expansion -- Memory T-cell subsets and function -- Part 2: What happens to the immune system during HIV-1 infection -- A closer look at the T-cell response to HIV-1 infection -- Establishing persistence - antigen overload -- How does HIV escape immunity? -- Immune-driven viral diversity -- HIV establishes immunodominance -- Cytokine network dysregulation in HIV-1 infection -- Gut Associated Lymphoid Tissue (GALT) and CD4+ depletion -- Part 3: Immunity associated with protection from HIV-1 infection: the case of commercial sex workers -- Evidence for low levels of HIV-1 infection in HEPS -- The role of HLA in protection in HEPS -- The influence of HLA on HIV-1 infection and disease progression -- Possible mechanisms of natural resistance to HIV-1 infection -- Part 4: T-cell based vaccines and immunogenicity -- Measurements of immunogenicity -- The significance of CTL and HLA in vaccine design -- Is the immune response to HIV-1 good or bad? -- Bibliography -- SECTION 3 HIV risk factors and prevention strategies -- CHAPTER 9 Reducing sexual risk behaviours: Theory and research, successes and challenges -- The prevalence of risky sexual behaviour -- The forces shaping sexual risk behaviour -- Personal factors -- The proximal context -- The distal context -- Theories about health behaviour and their role in tackling the forces shaping sexual risk behaviour -- Can sexual behaviour be changed? -- Addressing the personal and interpersonal influences on sexual risk behaviour -- Intervening in the proximal context to bring about community-level change -- Building health-enabling environments - the distal context -- Implementing and evaluating prevention programmes: some challenges -- Case Study -- Intervention -- Theoretical approach -- Was the project effective?.

Why did the project fail to reduce STI prevalence? -- Case Study -- Reducing women's economic vulnerability -- Increasing women's HIV prevention skills and changing the social environment -- Evidence of the effects of IMAGE -- Case Study -- Stepping Stones -- How did Stepping Stones attempt to reduce IPV, sexual risk behaviour and HIV incidence? -- Evidence of the effects of Stepping Stones -- Bibliography -- CHAPTER 10 Barrier methods -- Condom history and construction -- Efficacy of condoms -- Public sector condom distribution in South Africa -- Case study -- Condom social marketing -- Prevalence of condom use -- Barriers to condom use -- Interventions to promote condom use -- Improving accessibility -- New technology -- Other barrier methods for HIV prevention -- Conclusion -- Acknowledgements -- Bibliography -- CHAPTER 11 Mother-to-child transmission (MTCT) of HIV-1 -- The scale of the problem -- Routes of transmission -- Risk factors for transmission -- Prevention of transmission -- Safety of antiretrovirals used in MTCT trials -- Provision of services and implementation of research results -- Comprehensive approach to MTCT services -- Bibliography -- CHAPTER 12 Sexually transmitted infections -- Introduction -- The interaction between HIV and other STIs -- The prevalence of classical STIs in South Africa -- The treatment of STIs and the effect on HIV incidence -- Bibliography -- CHAPTER 13 Safe blood supplies -- Governance of the blood service -- Sufficient safe blood and the window period of HIV infectivity -- The Blood Safety Policy -- Outcome of the Blood Safety Policy -- The residual risk of a blood transfusion -- Informed consent and other legal aspects of blood transfusion -- The future -- Bibliography -- CHAPTER 14 Intravenous drug use in South Africa -- A brief history of South African injection drug use -- The present -- 'Tik'.

Needle exchange programmes -- The potential for South Africa -- Bibliography -- CHAPTER 15 Positive prevention interventions -- History of positive prevention -- Continued HIV transmission practices -- HIV transmission risks and antiretroviral therapy -- Effective positive prevention interventions -- Essential elements of positive prevention -- Managing HIV/AIDS stigma -- Disclosure rights and decision skills -- Aggressive STI control -- Attending to mental health and substance use -- Expanded access to antiretroviral therapy and adherence support -- Positive prevention within a comprehensive HIV prevention plan -- BIBLIOGRAPHY -- CHAPTER 16 New prevention strategies under development and investigation -- Vaccines -- Cellular immune responses -- Humoral immune responses -- Mucosal immune responses -- The prime-boost strategy -- South Africa's contribution to the AIDS vaccine -- Microbicides -- What are microbicides and why is their development important? -- Mechanisms of action -- Microbicide studies in South Africa -- Current state of clinical development of microbicides -- Obstacles to microbicide development -- Future for microbicides -- Antiretroviral therapy as a prevention strategy -- Pre-exposure prophylaxis -- Circumcision as a prevention strategy -- Bibliography -- SECTION 4 Focal groups for understanding the HIV epidemic -- CHAPTER 17 Heterosexual transmission of HIV - the importance of a gendered perspective in HIV prevention -- Heterosexual transmission of HIV -- Epidemiological factors influencing heterosexual spread of HIV -- Sex and age -- Migration and HIV -- Other sexually transmitted infections -- HIV transmission - biological mechanisms -- Preventing sexual transmission of HIV -- Abstinence and behaviour change -- Male condoms -- HIV prevention beyond the research setting.

Social and cultural factors influencing HIV risk reduction.