Modelling the impact of migration on the HIV epidemic in South Africa
Modelling the impact of migration on the HIV epidemic in South Africa
复制标题
DOI：
10.1097/qad.0b013e328011dac9
复制
发表时间：
2007-01-30
期刊：
影响因子：
3.8
通讯作者：
Garnett, Geoff P.
中科院分区：
文献类型：
--
作者：
Coffee, Megan;Lurie, Mark N.;Garnett, Geoff P.
目的：利用观察到的数据建立一个数学模型，估计移民对南非艾滋病毒传播的影响。方法：设计确定性数学模型，评估流动性、性行为、HIV和性传播感染之间的动态相互作用。该模型基于对南非夸祖鲁/纳塔尔省488名成年人的人口研究，其中包括男性移民、男性非移民和他们的农村伴侣。结果：该模型预测，人口迁移的影响取决于疫情的阶段和迁移模式。在疫情早期，不同艾滋病毒流行率人群之间的频繁移徙加速了艾滋病毒的传播；然而，当地的性危险行为决定了该流行病的最终规模。如果移民与移民男性的性风险行为增加相结合，正如南非社区所报告的那样，那么移民女性伴侣中的艾滋病毒感染率将增加10倍（1.8%至19%）。相反，如果移徙不经常发生，假定与移徙有关的危险行为保持在目前的水平，预测的流行病将是目前观察到的五分之一（2.8%对15.1%）。结论：移徙主要通过增加高危性行为影响艾滋病毒的传播，而不是通过连接低高风险地区和高风险地区。移徙者频繁返回加上性危险行为增加是一个重要的危险因素。因此，南非的干预方案需要专门针对短期移徙者的性行为，尽管这些人可能更难以识别。(c) 2007年Lippincott Williams & Wilkins。
Objective: To use observed data to develop a mathematical model that estimates the impact of migration on the spread of HIV in South Africa.Methods: A deterministic mathematical model was designed to evaluate the dynamic interactions between mobility, sexual behaviour, HIV, and sexually transmitted infections. The model was based on a population study of 488 adults, which included male migrants, male non-migrants and their rural partners in KwaZulu/Natal, South Africa.Results: The model predicted that the impact of migration depends upon the epidemic's stage and the pattern of migration. Early in the epidemic, frequent migration between populations with different HIV prevalence rates accelerated HIV spread; however, local sexual risk behaviour determined the eventual scale of the epidemic. If migration is coupled with increased sexual risk behaviour by migrant men, as has been reported in the South African communities studied, HIV prevalence would increase 10 times among migrants' female partners (1.8 to 19%). In contrast, if migration were to occur infrequently, with migration-associated risk behaviour assumed to be at current levels, the predicted epidemic would be one fifth that currently observed (2.8 versus 15.1%).Conclusions: Migration primarily influences HIV spread by increasing high-risk sexual behaviour, rather than by connecting areas of low and high risk. Frequent return of migrants is an important risk factor when coupled with increased sexual risk behaviour. Accordingly, intervention programmes in South Africa need to target the sexual behaviour of short-term migrants specifically, even though these individuals may be more difficult to identify. (c) 2007 Lippincott Williams & Wilkins.