East-West Center, Honolulu, Hawaii, USA.
Curr Opin HIV AIDS. 2019 Sep;14(5):337-353. doi: 10.1097/COH.0000000000000571.
To explore the comparative importance of HIV infections among key populations and their intimate partners as HIV epidemics evolve, and to review implications for guiding responses.
Even as concentrated epidemics evolve, new infections among current and former key population members and their intimate partners dominate new infections. Prevalent infections in the general population grow primarily because of key population turnover and infections among their intimate partners. In generalized epidemic settings, data and analysis on key populations are often inadequate to assess the impact of key population-focused responses, so they remain limited in coverage and under resourced. Models must incorporate downstream infections in comparing impacts of alternative responses.
Recognize that every epidemic is unique, moving beyond the overly simplistic concentrated/generalized epidemic paradigm that can misdirect resources. Guide HIV responses by gathering and using locally relevant data, understanding risk heterogeneity, and applying modeling at both national and sub-national levels to optimize resource allocations among different populations for greatest impact. Translate this improved understanding into clear, unequivocal advice for policymakers on where to focus for impact, breaking them free of the generalized/concentrated paradigm limiting their thinking and affecting their decisions.
探讨在 HIV 流行演变过程中，重点人群及其性伴侣中的 HIV 感染的相对重要性，并综述对指导应对措施的意义。
即使集中流行演变，当前和以前的重点人群成员及其性伴侣中的新感染仍占新感染的主导地位。一般人群中流行感染的增加主要是由于重点人群的更替和性伴侣中的感染。在广泛流行的环境中，关于重点人群的数据和分析通常不足以评估重点人群为重点的应对措施的影响，因此其覆盖面仍然有限且资源不足。模型必须将下游感染纳入比较替代应对措施的影响。
认识到每个流行都是独特的，超越可能误导资源的过于简单的集中/广泛流行的范例。通过收集和使用当地相关数据、了解风险异质性以及在国家和次国家层面应用模型，优化不同人群之间的资源分配，以实现最大影响，指导 HIV 应对措施。将这种改进的理解转化为明确、毫不含糊的政策建议，告诉决策者在哪里集中精力产生影响，使他们摆脱限制他们思维和影响他们决策的广泛/集中的范例。
