University of California, Berkeley, 207 Giannini Hall, Berkeley, CA 94720, USA.
Demography. 2011 Nov;48(4):1401-28. doi: 10.1007/s13524-011-0060-1.
HIV risks decline sharply at age 30 for women in South Africa, long before coital frequencies or pregnancies decrease. I evaluate several prominent behavioral models of HIV, and find that these do not suggest sharply decreasing risks with age. I formulate a model of spousal search and find that "marital shopping" can generate epidemic HIV prevalence despite low transmission rates because search behavior interacts with dynamics of HIV infectiousness. The implied age-infection profile closely mimics that in South Africa, and the suggested behavior matches that reported by South Africans. Condom use in new relationships and transmission rate reductions are both found to be effective policies and, when used together, eliminate the potential of spousal search to spread HIV. In contrast, antiretroviral treatment is found to have only a minimal effect on the epidemic.
南非女性在 30 岁时，HIV 风险急剧下降，远早于性行为频率或怀孕率下降。我评估了几种著名的 HIV 行为模型，发现这些模型并没有表明年龄增长会带来风险的急剧下降。我提出了一个配偶搜索模型，并发现尽管传播率较低，但“婚姻选择”可能会导致 HIV 流行率上升，因为搜索行为与 HIV 传染性的动态相互作用。所暗示的年龄感染特征与南非的情况非常相似，建议的行为与南非人报告的行为相符。我发现，在新的关系中使用避孕套和降低传播率都是有效的政策，两者结合使用可以消除配偶搜索传播 HIV 的可能性。相比之下，抗逆转录病毒治疗对疫情的影响微乎其微。
