Foss Anna M, Prudden Holly J, Mitchell Kate M, Pickles Michael, Washington Reynold, Phillips Anna E, Alary Michel, Boily Marie-Claude, Moses Stephen, Watts Charlotte H, Vickerman Peter T
Department of Global Health and Development and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.
Infect Dis Model. 2020 Sep 30;5:798-813. doi: 10.1016/j.idm.2020.09.007. eCollection 2020.
We used reported behavioural data from cisgender men who have sex with men and transgender women (MSM/TGW) in Bangalore, mainly collected from 'hot-spot' locations that attract MSM/TGW, to illustrate a technique to deal with potential issues with the representativeness of this sample. A deterministic dynamic model of HIV transmission was developed, incorporating three subgroups of MSM/TGW, grouped according to their reported predominant sexual role (insertive, receptive or versatile). Using mathematical modelling and data triangulation for 'balancing' numbers of partners and role preferences, we compared three different approaches to determine if our technique could be useful for inferring characteristics of a more 'hidden' insertive MSM subpopulation, and explored their potential importance for the HIV epidemic. Projections for 2009 across all three approaches suggest that HIV prevalence among insertive MSM was likely to be less than half that recorded in the surveys (4.5-6.5% versus 13.1%), but that the relative size of this subgroup was over four times larger (61-69% of all MSM/TGW versus 15%). We infer that the insertive MSM accounted for 10-20% of all prevalent HIV infections among urban males aged 15-49. Mathematical modelling can be used with data on 'visible' MSM/TGW to provide insights into the characteristics of 'hidden' MSM. A greater understanding of the sexual behaviour of all MSM/TGW is important for effective HIV programming. More broadly, a hidden subgroup with a lower infectious disease prevalence than more visible subgroups, has the potential to contain more infections, if the hidden subgroup is considerably larger in size.
我们使用了来自班加罗尔与男性发生性关系的顺性别男性及跨性别女性（男男性行为者/跨性别女性，MSM/TGW）的报告行为数据，这些数据主要从吸引MSM/TGW的“热点”地点收集，以阐述一种处理该样本代表性潜在问题的技术。我们开发了一个HIV传播的确定性动态模型，纳入了MSM/TGW的三个亚组，根据他们报告的主要性角色（插入方、接受方或双性角色）进行分组。通过数学建模和数据三角测量来“平衡”性伴侣数量和角色偏好，我们比较了三种不同方法，以确定我们的技术是否有助于推断更“隐蔽”的插入方男男性行为者亚人群的特征，并探讨了它们对HIV流行的潜在重要性。2009年所有三种方法的预测表明，插入方男男性行为者中的HIV流行率可能不到调查记录的一半（4.5 - 6.5%对13.1%），但该亚组的相对规模超过四倍（占所有MSM/TGW的61 - 69%对15%）。我们推断，插入方男男性行为者占15 - 49岁城市男性中所有HIV现患感染的10 - 20%。数学建模可与“可见”的MSM/TGW数据一起使用，以深入了解“隐蔽”男男性行为者的特征。更全面地了解所有MSM/TGW的性行为对于有效的HIV规划很重要。更广泛地说，如果一个隐蔽亚组的规模相当大，那么一个传染病流行率低于更明显亚组的隐蔽亚组有可能包含更多感染病例。
