Gorbach Pamina M, Holmes King K
Department of Epidemiology, School of Public Health, University of California, Los Angeles 90095-1772, USA.
J Urban Health. 2003 Dec;80(4 Suppl 3):iii15-25. doi: 10.1093/jurban/jtg079.
Mathematical modeling of transmission dynamics of sexually transmitted infections (STIs) and HIV has considerably advanced HIV research by highlighting the importance of certain types of partnerships in epidemic spread. Notably, concurrent partnerships, defined as a sexual partnership in which one or more of the partnership members have other sexual partners while continuing sexual activity with the original partner, have been shown to play a fundamental role in potentiating the spread of STIs and HIV. Risk behaviors such as concurrency and sex without condoms as well as STI/HIV prevalence vary with physical, social, and emotional factors within partnerships. The efficiency of STI/HIV transmission appears to vary across types of concurrent partnerships according to the differing dynamics within them. Previous research on partnership dynamics has improved our understanding of the multidimensional aspects of sexual partnering, but little is understood of how these aspects of sexual partnering interact and increase risks for HIV, nor how types of partnerships, partnership dynamics, and concurrency work together to affect both the behavior of condom use and the biological transmission of disease. In this article, we discuss the need to extend our understanding of concurrency to include partnerships among men who have sex with men (MSM) and to differentiate between types of partnerships and to develop interventions to modify risk within partnerships. We also introduce a conceptual framework that reflects how individual and partner characteristics influence partnership dynamics that in turn influence risk behaviors, such as concurrency and not using condoms, and associated risks for STIs and HIV.
性传播感染（STIs）和艾滋病毒传播动力学的数学模型通过突出某些类型的性伙伴关系在疫情传播中的重要性，极大地推动了艾滋病毒研究。值得注意的是，同时存在多个性伙伴关系，定义为其中一个或多个性伙伴在与原伴侣继续性行为的同时还有其他性伙伴的性伙伴关系，已被证明在促进性传播感染和艾滋病毒传播方面发挥着重要作用。诸如同时存在多个性伙伴和不使用避孕套进行性行为等风险行为以及性传播感染/艾滋病毒的流行率会因性伙伴关系中的身体、社会和情感因素而有所不同。根据其中不同的动态情况，性传播感染/艾滋病毒传播的效率在不同类型的同时存在多个性伙伴关系中似乎也有所不同。先前关于性伙伴关系动态的研究增进了我们对性伙伴关系多维度方面的理解，但对于性伙伴关系的这些方面如何相互作用并增加艾滋病毒感染风险，以及不同类型的性伙伴关系、性伙伴关系动态和同时存在多个性伙伴关系如何共同作用以影响避孕套使用行为和疾病的生物传播，我们了解得还很少。在本文中，我们讨论了有必要扩展我们对同时存在多个性伙伴关系的理解，将男男性行为者（MSM）之间的性伙伴关系包括在内，区分不同类型的性伙伴关系，并制定干预措施以改变性伙伴关系中的风险。我们还引入了一个概念框架，该框架反映了个体和性伙伴特征如何影响性伙伴关系动态，进而影响诸如同时存在多个性伙伴和不使用避孕套等风险行为以及性传播感染和艾滋病毒的相关风险。
