Center for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, United States.
The African Comprehensive HIV/AIDS Partnerships (ACHAP), Gaborone, Botswana.
Elife. 2023 Sep 4;12:e85435. doi: 10.7554/eLife.85435.
The majority of people with HIV live in sub-Saharan Africa, where epidemics are generalized. For these epidemics to develop, populations need to be mobile. However, the role of population-level mobility in the development of generalized HIV epidemics has not been studied. Here we do so by studying historical migration data from Botswana, which has one of the most severe generalized HIV epidemics worldwide; HIV prevalence was 21% in 2021. The country reported its first AIDS case in 1985 when it began to rapidly urbanize. We hypothesize that, during the development of Botswana's epidemic, the population was extremely mobile and the country was highly connected by substantial migratory flows. We test this mobility hypothesis by conducting a network analysis using a historical time series (1981-2011) of micro-census data from Botswana. Our results support our hypothesis. We found complex migration networks with very high rates of rural-to-urban, and urban-to-rural, migration: 10% of the population moved annually. Mining towns (where AIDS cases were first reported, and risk behavior was high) were important in-flow and out-flow migration hubs, suggesting that they functioned as 'core groups' for HIV transmission and dissemination. Migration networks could have dispersed HIV throughout Botswana and generated the current hyperendemic epidemic.
大多数艾滋病毒感染者生活在撒哈拉以南非洲,那里的艾滋病疫情普遍存在。为了使这些疫情蔓延,人群必须具有流动性。然而,人群流动性在普遍艾滋病疫情的发展中的作用尚未得到研究。在这里,我们通过研究博茨瓦纳的历史迁移数据来研究这一问题,博茨瓦纳是全球艾滋病疫情最严重的国家之一;2021 年,艾滋病毒的流行率为 21%。该国于 1985 年首次报告艾滋病病例,当时它开始迅速城市化。我们假设,在博茨瓦纳艾滋病疫情的发展过程中,人口流动非常频繁,该国通过大量的迁移流紧密相连。我们通过使用博茨瓦纳的微观普查数据的历史时间序列(1981-2011 年)进行网络分析来检验这一流动性假设。我们的结果支持我们的假设。我们发现了具有非常高的城乡间迁移率的复杂迁移网络:10%的人口每年迁移。采矿业城镇(艾滋病病例首次报告的地方,风险行为很高)是重要的流入和流出迁移中心,这表明它们是艾滋病毒传播和扩散的“核心群体”。迁移网络可能已经在博茨瓦纳各地传播了艾滋病毒,并导致了目前的高度流行疫情。
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