Dynamic sex roles among men who have sex with men and transmissions from primary HIV infection.
Dynamic sex roles among men who have sex with men and transmissions from primary HIV infection.
复制标题
DOI：
10.1097/ede.0b013e3181e9e901
复制
发表时间：
2010-09
期刊：
影响因子：
--
通讯作者：
Koopman JS
中科院分区：
文献类型：
--
作者：
Alam SJ;Romero-Severson E;Kim JH;Emond G;Koopman JS
以前的研究估计了原发艾滋病毒携带者的传播比例，并没有集中在男性同性恋人群中性别角色转换的影响上。这种行为波动可能会增加原发艾滋病毒在整个人口中的贡献。我们用4个行为组定义的8个隔间对HIV传播进行建模，包括不同的插入肛门和接受肛门的组合，以及感染的两个阶段。我们探索了波动的行为类别对地方性流行率和通过原发艾滋病毒传播的比例的影响。我们改变了转换率，以发展关于行为波动如何影响感染模式的理论，并使用荷兰队列中的转换率来评估真实环境中的总体影响。在荷兰队列中观察到的行为群体状态随时间的变化动态放大了感染的流行率和来自原发艾滋病毒的传播比例，导致来自原发艾滋病毒携带者的传播比例最高。双重或接受期和非肛门性交期之间的波动主要决定了这种放大。在总传播量方面，双重角色风险群体占主导地位。插入作用和接受作用之间的波动减少了原发艾滋病毒传播的比例，但这种波动很少观察到。插入性行为和接受性肛交行为的波动显著增加了原发艾滋病毒的传播比例。即使在初次感染艾滋病毒或后来的感染状态不影响危险行为时，这种增加也会发生。因此，决定原发艾滋病毒传播比例的不仅仅是生物学，还有行为模式和社会背景。此外，每一次初次艾滋病毒传播比每一次后来的感染传播具有更大的人口影响，因为从第一次传播艾滋病毒的男子比后来感染艾滋病毒的男子承担更多的传播链。减少原发艾滋病毒的传播应是艾滋病毒控制工作的主要重点。
Previous studies estimating the fraction of transmissions from persons with primary HIV have not focused on the effects of switching sex role in male homosexual populations. Such behavioral fluctuations can increase the contribution of primary HIV in the overall population. We modeled HIV transmission with 8 compartments defined by 4 behavioral groups, with different anal-insertive and anal-receptive combinations, and 2 stages of infection. We explored the effects of fluctuating behavioral categories on endemic prevalence and the fraction of transmissions from primary HIV. We varied transition rates to develop the theory on how behavioral fluctuation affects infection patterns, and we used the transition rates in a Netherlands cohort to assess overall effects in a real setting. The dynamics of change in behavior-group status over time observed in the Netherlands cohort amplifies the prevalence of infection and the fraction of transmissions from primary HIV, resulting in the highest proportions of transmissions being from people with primary HIV. Fluctuation between dual- or receptive-role periods and no-anal-sex periods mainly determines this amplification. In terms of the total transmissions, the dual-role risk group is dominant. Fluctuation between insertive and receptive roles decreases the fraction of transmissions from primary HIV, but such fluctuation is infrequently observed. The fraction of transmissions from primary HIV is considerably raised by fluctuations in insertive and receptive anal sex behaviors. This increase occurs even when primary HIV or later infection status does not influence risk behavior. Thus, it is not simply biology but also behavior patterns and social contexts that determine the fraction of transmissions from primary HIV. Moreover, each primary HIV transmission has a larger population effect than each later infection transmission because the men to whom one transmits from primary HIV carry on more chains of transmissions than the men to whom one transmits later in infection. Reducing transmissions from primary HIV should be a primary focus of HIV control efforts.