Department of Anthropology, University of Washington, Seattle, USA.
AIDS Behav. 2012 Feb;16(2):312-22. doi: 10.1007/s10461-010-9858-x.
This paper explores the roles of acute infection and concurrent partnerships in HIV transmission dynamics among young adults in Zimbabwe using realistic representations of the partnership network and all published estimates of stage-specific infectivity. We use dynamic exponential random graph models to estimate partnership network parameters from an empirical study of sexual behavior and drive a stochastic simulation of HIV transmission through this dynamic network. Our simulated networks match observed frequencies and durations of short- and long-term partnerships, with concurrency patterns specific to gender and partnership type. Our findings suggest that, at current behavior levels, the epidemic cannot be sustained in this population without both concurrency and acute infection; removing either brings transmission below the threshold for persistence. With both present, we estimate 20-25% of transmissions stem from acute-stage infections, 30-50% from chronic-stage, and 30-45% from AIDS-stage. The impact of acute infection is strongly moderated by concurrency. Reducing this impact by reducing concurrency could potentially end the current HIV epidemic in Zimbabwe.
本文利用伙伴关系网络的现实表示和所有已发表的特定阶段传染性估计值，探讨了急性感染和同时发生的伙伴关系在津巴布韦青年成年人中 HIV 传播动态中的作用。我们使用动态指数随机图模型从性行为的实证研究中估计伙伴关系网络参数，并通过这个动态网络进行 HIV 传播的随机模拟。我们模拟的网络与短期和长期伙伴关系的实际频率和持续时间相匹配，具有特定于性别和伙伴关系类型的并发模式。我们的研究结果表明，在当前的行为水平下，如果没有同时发生急性感染和并发感染，这种人群中的艾滋病疫情就无法持续；如果去除其中任何一种因素，传播就会低于持续存在的阈值。如果同时存在这两种因素，我们估计 20-25%的传播源自急性感染期，30-50%源自慢性感染期，30-45%源自艾滋病期。急性感染的影响受到并发感染的强烈调节。通过减少并发感染来降低这种影响，有可能终结津巴布韦当前的艾滋病疫情。
