Morris M, Dean L
Department of Sociology, Columbia University, New York, NY 10025.
Am J Epidemiol. 1994 Aug 1;140(3):217-32. doi: 10.1093/oxfordjournals.aje.a117241.
Substantial changes in human immunodeficiency virus (HIV)-related sexual behavior have been reported by virtually every survey of homosexual/bisexual men in the last decade. This paper uses a behavior-based simulation to examine how such changes are likely to affect the long-term future of the acquired immunodeficiency syndrome (AIDS) epidemic among homosexual men. Data from the Longitudinal AIDS Impact Project in New York City are used to estimate age-specific patterns of unprotected anogenital contact and behavioral change from 1980 to 1991. Model projections are validated using New York City surveillance data on AIDS incidence from 1981 to 1991. The current levels of unsafe sex reported in the Longitudinal AIDS Impact Project are shown to be almost exactly on the epidemic threshold. If this behavior were maintained, HIV prevalence would slowly decline in the population, but with just one additional unsafe sexual partner per year HIV would instead become endemic, with seroprevalence of about 65% in the oldest group and about 25% in the youngest. Transmission dynamics in the youngest group are analyzed in detail. For this group, the assortative age-matching bias in partner selection patterns raises the unsafe behavior threshold slightly in the long run.
在过去十年中，几乎每项针对男同性恋者/双性恋男性的调查都报告了与人类免疫缺陷病毒（HIV）相关的性行为发生了重大变化。本文采用基于行为的模拟方法，研究这些变化可能如何影响男同性恋者中获得性免疫缺陷综合征（AIDS）流行的长期未来。利用纽约市纵向艾滋病影响项目的数据，估计了1980年至1991年期间特定年龄的无保护肛门生殖器接触模式和行为变化。使用1981年至1991年纽约市艾滋病发病率的监测数据对模型预测进行验证。纵向艾滋病影响项目报告的当前不安全性行为水平显示几乎恰好处于流行阈值。如果维持这种行为，人群中的HIV流行率将缓慢下降，但如果每年仅增加一个不安全的性伴侣，HIV反而会成为地方病，在最年长组中的血清流行率约为65%，在最年轻组中约为25%。详细分析了最年轻组中的传播动态。对于该组，伴侣选择模式中的年龄匹配偏差从长远来看会略微提高不安全行为阈值。
