Poor medical practice may be to blame for the spread of Aids through Africa.
New research based on hundreds of studies suggests only about a third of HIV infections in Africa are sexually transmitted.
The authors suggest contaminated medical injections make up the biggest risk.
They said their findings have "major ramifications for current and future HIV control in Africa, whose focus has been almost exclusively on sexual risk reduction and condom use".
The study is in today's International Journal of STD and AIDS, published by the Royal Society of Medicine. The research team is led by Pennsylvania anthropologist Dr David Gisselquist.
They say HIV cases in Africa have not followed the pattern of most types of sexually transmitted disease.
Many studies reported young children infected with HIV even though their mothers were not.
Typically STDs are associated with being poor and uneducated but HIV in Africa is linked with urban living, having a good education and higher income.
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