According to UNAIDS, several factors fuel the spread of HIV in the DR Congo, including movement of large numbers of refugees and soldiers, scarcity and high cost of safe blood transfusions in rural areas, a lack of counseling, few HIV testing sites, high levels of untreated sexually transmitted infections among sex workers and their clients, and low availability of condoms outside Kinshasa and one or two provincial capitals.
Examples of sexually transmitted infections that may affect the anorectal area are syphilis, herpes, chlamydia and human papilloma virus.