A P R I L  2 0 1 1                                    T H E  S O U T H E R N  A F R I C A N  J O U R N A L  O F  H I V  M E D I C I N E

To the Editor: We refer to the article by Parkhurst and 
Whiteside in the April 2010 issue of the Southern African 
Journal of HIV Medicine.1 The authors suggest that a 
limited period of population-wide sexual abstinence 
might be an effective and low-cost method of interrupting 
the transmission of HIV, particularly among individuals 
with acute HIV infection (AHI).

Evidence is mounting that a large proportion of HIV 
transmission may be attributed to individuals who are 
in the acute phase of HIV infection, best described as 
the time period during which HIV can be detected in 
blood serum and plasma but before the formation of 
antibodies, as measured by standard assays.2 The viral 
burden in blood and genital secretions is particularly 
high during this brief period, resulting in individuals with 
AHI being highly infectious.3,4 They are often unaware of 
their status or believe themselves to be HIV negative.

We conducted formative research with individuals with 
AHI from October 2007 to June 2008 in Lilongwe, Malawi, 
and Johannesburg, South Africa. Under the auspices of 
CHAVI (the Center for HIV/AIDS Vaccine Immunology) 
the research aimed to gain a better understanding of the 
sexual risk behaviours of individuals with AHI at the time 
of infection and immediately thereafter to assist with 
recruitment of such individuals into a formative cohort 
(CHAVI 001) and begin investigation into potential 
interventions for this period of high infectivity.

Our sample included 37 individuals identified with AHI during 
this time period. During in-depth interviews participants 
were asked to comment on topics to include in a potential 
intervention for individuals with AHI and intervention 
delivery strategies. We explicitly asked about the feasibility 
and acceptability of two potential interventions to interrupt 
HIV transmission during the acute period: 100% condom 
use or abstinence for 3 months.

More detailed information from this study on sexual 
behaviour at the time of infection and responses to 
proposed intervention activities is available elsewhere.5 
In general, however, there was limited support for a 
period of enforced abstinence, given partner reluctance, 
the need to disclose to partners and, in South Africa, a 
strongly expressed desire for children. Individuals with 
AHI in Malawi had more positive attitudes to abstinence 
than those in South Africa, but believed that intensive 
counselling and support would be required.

An intervention to reduce risk behaviours during AHI 
is currently being developed in Lilongwe, Malawi. The 
HPTN 062 study is evaluating the acceptability and 
feasibility of an enhanced, individual-level counselling 
intervention for individuals in the acute and early phase 
of HIV infection. Data collected will provide further 
understanding of the feasibility of abstaining during the 
acute period. Results are expected in 2012.

While a limited period of abstinence might theoretically 
be effective for limiting HIV transmission, the realities 
of implementation are likely to be challenging. Support 
for such a strategy was limited in this population of 
individuals with known HIV infection, despite their 
ongoing participation and support in an observational 
study. There is likely to be even less support from 
individuals who do not know their status or who do not 
perceive themselves to be at risk of infection.

C MacPhail 
Wits Institute for Sexual and Reproductive Health, HIV 
and Related Diseases, Johannesburg

A Pettifor
Gillings School of Public Health, University of North 
Carolina, USA

A Corneli 
Family Health International

NIAD Center for HIV/AIDS Vaccine Immunology

REFERENCES
1.    Parkhurst JO, Whiteside A. Innovative responses for preventing HIV transmission: 

The protective value of population-wide interruptions of risk activity. Southern 
African Journal of HIV Infection 2010;11(1):19-21.

2.    Pilcher CD, Eron JJ Jr, Galvin S, Gay C, Cohen MS. Acute HIV revisited: new 
opportunities for treatment and prevention. J Clin Invest 2004;113(7):937-945.

3.    Pilcher CD, Tien HC, Eron JJ, Jr., Vernazza PL, Leu SY, Stewart PW, et al. Brief 
but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis 
2004;189(10):1785-1792.

4.    Pilcher C, Shugars D, Fiscus S, Miller W, Menezes P, Giner J, et al. HIV in body 
fluids during primary HIV infection: implications for pathogenesis, treatment and 
public health. AIDS Annals Africa 2001;15(7):837-845.

5.   Pettifor A, MacPhail C, Corneli A, et al. Continued high risk sexual behavior following 
diagnosis with acute HIV Infection in South Africa and Malawi: implications for 
prevention. AIDS Behav 2010;  Oct 27, Epub ahead of print.

FEASIBILITY AND ACCEPTABILITY OF SEXUAL 
ABSTINENCE FOR INTERRUPTION OF HIV 

TRANSMISSION AMONG INDIVIDUALS WITH 
ACUTE HIV INFECTION – FORMATIVE DATA 

FROM CHAVI 011

L E T T E R

Research referred to in this correspondence was supported 
by the NIAD Center for HIV/AIDS Vaccine Immunology grant 
AI067854.

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