What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)?
What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)?
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DOI：
10.1371/journal.pone.0050522
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Buchbinder SP
中科院分区：
文献类型：
--
作者：
Goodreau SM;Carnegie NB;Vittinghoff E;Lama JR;Sanchez J;Grinsztejn B;Koblin BA;Mayer KH;Buchbinder SP
在这项工作中，我们估计的传播比例发生在主要与偶然的伙伴关系，并通过性角色，感染阶段，测试和治疗历史的受感染的合作伙伴，为男性与男性发生性关系（MSM）在美国和秘鲁。我们使用基于指数随机图模型（ERGMs）的动态随机模型，从多个大规模MSM调查中获得输入。平行的主要伙伴关系和休闲的性网络进行了模拟。每个人的特征是年龄，种族，包皮环切状态，性角色行为和无保护肛交（UAI）的倾向;他的历史是从进入成年人群开始建模的，潜在的转变包括HIV感染，检测，治疗，艾滋病诊断和死亡。我们实施了两种模型变体，它们在急性传染性的假设上不同，并评估了对其他关键输入的敏感性。我们的两个模型表明，只有4-5%（模型1）或22-29%（模型2）的艾滋病毒传播是由于与急性期伴侣的接触;多数（分别为80-81%和49%）来自慢性期伴侣，其余（分别为14-16%和27- 35%）来自艾滋病期伴侣。类似比例的感染来自感染未被诊断（24-31%），诊断但未治疗（36-46%）和目前正在治疗（30-36%）的伴侣。大约三分之一的感染（32-39%）发生在主要的伴侣关系中。尽管存在关键的行为差异，但各国的结果在质量上相似;一个例外是，从接受性伴侣到插入性伴侣的传播在秘鲁（34%）比美国（21%）更重要。传播背景的广泛平衡表明，有关风险的教育，仔细评估，暴露前预防，更频繁的检测，早期治疗，降低风险，披露，并坚持咨询，可能都有助于大大减少艾滋病毒的发病率在美国和秘鲁的男男性行为者。
In this work, we estimate the proportions of transmissions occurring in main vs. casual partnerships, and by the sexual role, infection stage, and testing and treatment history of the infected partner, for men who have sex with men (MSM) in the US and Peru. We use dynamic, stochastic models based in exponential random graph models (ERGMs), obtaining inputs from multiple large-scale MSM surveys. Parallel main partnership and casual sexual networks are simulated. Each man is characterized by age, race, circumcision status, sexual role behavior, and propensity for unprotected anal intercourse (UAI); his history is modeled from entry into the adult population, with potential transitions including HIV infection, detection, treatment, AIDS diagnosis, and death. We implemented two model variants differing in assumptions about acute infectiousness, and assessed sensitivity to other key inputs. Our two models suggested that only 4–5% (Model 1) or 22–29% (Model 2) of HIV transmission results from contacts with acute-stage partners; the plurality (80–81% and 49%, respectively) stem from chronic-stage partners and the remainder (14–16% and 27–35%, respectively) from AIDS-stage partners. Similar proportions of infections stem from partners whose infection is undiagnosed (24–31%), diagnosed but untreated (36–46%), and currently being treated (30–36%). Roughly one-third of infections (32–39%) occur within main partnerships. Results by country were qualitatively similar, despite key behavioral differences; one exception was that transmission from the receptive to insertive partner appears more important in Peru (34%) than the US (21%). The broad balance in transmission contexts suggests that education about risk, careful assessment, pre-exposure prophylaxis, more frequent testing, earlier treatment, and risk-reduction, disclosure, and adherence counseling may all contribute substantially to reducing the HIV incidence among MSM in the US and Peru.
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DOI：
10.1097/ede.0b013e3181ce9950
发表时间：
2010-07
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Chu H;Gange SJ;Li X;Hoover DR;Liu C;Chmiel JS;Jacobson LP
通讯作者：
Jacobson LP
影响因子：
6.4
作者：
Brenner, Bluma G.;Roger, Michel;Wainberg, Mark A.
通讯作者：
Wainberg, Mark A.
影响因子：
3.8
作者：
BUCHBINDER, SP;KATZ, MH;HOLMBERG, SD
通讯作者：
HOLMBERG, SD
DOI：
10.1097/01.qai.0000221677.29693.dd
发表时间：
2006-08-01
影响因子：
3.6
作者：
Lama, Javier R.;Sanchez, Jorge;Grant, Robert M.
通讯作者：
Grant, Robert M.
影响因子：
3.8
作者：
Jansen, Iralice A. V.;Geskus, Ronald B.;Stolte, Ineke G.
通讯作者：
Stolte, Ineke G.