Stone Jack, Mukandavire Christinah, Boily Marie-Claude, Fraser Hannah, Mishra Sharmistha, Schwartz Sheree, Rao Amrita, Looker Katharine J, Quaife Matthew, Terris-Prestholt Fern, Marr Alexander, Lane Tim, Coetzee Jenny, Gray Glenda, Otwombe Kennedy, Milovanovic Minja, Hausler Harry, Young Katherine, Mcingana Mfezi, Ncedani Manezi, Puren Adrian, Hunt Gillian, Kose Zamakayise, Phaswana-Mafuya Nancy, Baral Stefan, Vickerman Peter
Population Health Sciences, University of Bristol, Bristol, United Kingdom.
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
J Int AIDS Soc. 2021 Jan;24(1):e25650. doi: 10.1002/jia2.25650.
INTRODUCTION: In generalized epidemic settings, there is insufficient understanding of how the unmet HIV prevention and treatment needs of key populations (KPs), such as female sex workers (FSWs) and men who have sex with men (MSM), contribute to HIV transmission. In such settings, it is typically assumed that HIV transmission is driven by the general population. We estimated the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa (SA). METHODS: We developed the "Key-Pop Model"; a dynamic transmission model of HIV among FSWs, their clients, MSM, and the broader population in SA. The model was parameterized and calibrated using demographic, behavioural and epidemiological data from national household surveys and KP surveys. We estimated the contribution of commercial sex, sex between men and sex among heterosexual partnerships of different sub-groups to HIV transmission over 2010 to 2019. We also estimated the efficiency (HIV infections averted per person-year of intervention) and prevented fraction (% IA) over 10-years from scaling-up ART (to 81% coverage) in different sub-populations from 2020. RESULTS: Sex between FSWs and their paying clients, and between clients with their non-paying partners contributed 6.9% (95% credibility interval 4.5% to 9.3%) and 41.9% (35.1% to 53.2%) of new HIV infections in SA over 2010 to 2019 respectively. Sex between low-risk groups contributed 59.7% (47.6% to 68.5%), sex between men contributed 5.3% (2.3% to 14.1%) and sex between MSM and their female partners contributed 3.7% (1.6% to 9.8%). Going forward, the largest population-level impact on HIV transmission can be achieved from scaling up ART to clients of FSWs (% IA = 18.2% (14.0% to 24.4%) or low-risk individuals (% IA = 20.6% (14.7 to 27.5) over 2020 to 2030), with ART scale-up among KPs being most efficient. CONCLUSIONS: Clients of FSWs play a fundamental role in HIV transmission in SA. Addressing the HIV prevention and treatment needs of KPs in generalized HIV epidemics is central to a comprehensive HIV response.
引言：在普遍流行的情况下，人们对关键人群（如女性性工作者和男男性行为者）未得到满足的艾滋病毒预防和治疗需求如何导致艾滋病毒传播了解不足。在这种情况下，通常认为艾滋病毒传播是由普通人群驱动的。我们估计了商业性行为、男性之间的性行为以及其他异性恋伴侣关系对南非艾滋病毒传播的贡献。 方法：我们开发了“关键人群模型”；这是一个关于南非女性性工作者、她们的客户、男男性行为者以及更广泛人群中艾滋病毒的动态传播模型。该模型使用来自全国家庭调查和关键人群调查的人口统计学、行为学和流行病学数据进行参数化和校准。我们估计了2010年至2019年期间商业性行为、男性之间的性行为以及不同亚组异性恋伴侣之间的性行为对艾滋病毒传播的贡献。我们还估计了从2020年起在不同亚人群中扩大抗逆转录病毒治疗（至81%的覆盖率）在10年内的效率（每人年干预避免的艾滋病毒感染数）和预防比例（%IA）。 结果：2010年至2019年期间，女性性工作者与其付费客户之间的性行为以及客户与非付费伴侣之间的性行为分别占南非新增艾滋病毒感染的6.9%（95%可信区间4.5%至9.3%）和41.9%（35.1%至53.2%）。低风险群体之间的性行为占59.7%（47.6%至68.5%），男性之间的性行为占5.3%（2.3%至14.1%），男男性行为者与其女性伴侣之间的性行为占3.7%（1.6%至9.8%）。展望未来，可以通过在2020年至2030年期间将抗逆转录病毒治疗扩大到女性性工作者的客户（%IA = 18.2%（14.0%至24.4%））或低风险个体（%IA = 20.6%（14.7至27.5））来实现对艾滋病毒传播的最大人群层面影响，在关键人群中扩大抗逆转录病毒治疗最为有效。 结论：女性性工作者的客户在南非艾滋病毒传播中起着根本性作用。在普遍的艾滋病毒流行中满足关键人群的艾滋病毒预防和治疗需求是全面应对艾滋病毒的核心。
J Int AIDS Soc. 2021-1
J Acquir Immune Defic Syndr. 2021-4-1
J Acquir Immune Defic Syndr. 2024-1-1
J Acquir Immune Defic Syndr. 2025-8-14
JMIR Public Health Surveill. 2025-1-9
SSM Popul Health. 2019-10-18
Zotero 插件
