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The global HIV epidemic may have peaked. In southern India (
) the age-standardised prevalence of HIV-1 infection among young women in antenatal clinics fell by 35% (from 1.7% to 1.1%) during 2000–2004 and among young men in sexually transmitted disease clinics there was a similar fall in prevalence (36%, from 20.9% to 13.3%). In Africa (Comment, ibid: 1120–2) HIV incidence has also fallen. In Kenya the incidence among people aged 15–49 years peaked around 1992–93 and has since fallen to a very low level. The peak incidence in Uganda and Zambia was around 1987, in Botswana and Lesotho around 1994, and in South Africa around 1997. The declines can be attributed both to the natural course of epidemics (the most susceptible people become infected early in an epidemic and the pool of susceptibles shrinks) and to behavioural changes. Behavioural change has been important. In southern India the falling prevalence among young people has been attributed largely to increased use of condoms by young men and among female sex workers.
People with myelomeningocele and a dysfunctional bladder may need cystoplasty. The operation has usually been done using gastrointestinal segments but there are many complications. Now US researchers (
, see also Comment, ibid: 1215–6) have used tissue-engineering techniques to generate autologous bladder tissue for cystoplasty in seven patients aged 4–19 years with myelomeningocele. Bladder …