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M94A2529.TXT
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1994-10-25
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Document 2529
DOCN M94A2529
TI The effect of a transient period with high risk contacts on the dynamics
of the HIV epidemic.
DT 9412
AU Wittkowski KM; Hasan M; Dept. Med. Biometry, Univ. Tubingen, Germany.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):283 (abstract no. PC0053). Unique
Identifier : AIDSLINE ICA10/94370046
AB OBJECTIVE: In Arab countries, the low reported AIDS incidence--even when
adjusted for under reporting--might lead to the impression that 'the
West has condoms, we have the Quran'. We discuss how different
traditions regarding sexual behaviour among young adults may affect the
spread of HIV. METHODS: HIV is assumed to spread from a core-group
(highly promiscuous homosexual men) via a high-risk group
(homo-/bisexual men, injecting drug users) and heterosexual partners to
low-risk heterosexuals. The parameters of this model (size of
sub-populations, behavioural changes, contact rates) are fitted against
back-calculation estimates for HIV incidence in Germany based on
reported, delay-corrected AIDS cases. The results are compared with a
model, where the higher-risk groups are smaller and have lower contact
rates, while behavioural changes are less effective and 5 percent of the
heterosexuals have a 5-year period with high risk (e.g. anal) contacts
before entering the low risk population. RESULTS: In western countries,
HIV incidence among high-risk groups and their heterosexual partners
peaked in 1983-85 and 1987-1989, respectively. Because here the basic
reproduction number among heterosexuals can only minimally exceed the
critical value of 1, HIV incidence will remain well below 1/100,000 per
year for the next few decades, although it may increase thereafter.
Where a transient period of high-risk behaviour cannot be excluded,
however, HIV can spread much faster into the heterosexual population,
and the incidence may reach 3/100,000 among low-risk heterosexuals per
year (and the prevalence 30/100,000) by the year 2000, even if only
relatively few high-risk persons are infected. DISCUSSION AND
CONCLUSIONS: A transient period of high-risk behaviour may facilitate
the spread of HIV for two reasons. First, even 5 percent of the
population are a huge pool for the virus and the short duration hinders
saturation. Second, transport (at the end of the transient period) is
more effective than transmission (through heterosexual contact). That no
peak in incidence among high-risk groups has been observed until now in
Arab countries, must not be mistaken as an indication that HIV is
spreading as slowly among heterosexuals as in western countries.
DE Germany/EPIDEMIOLOGY Human HIV Infections/*EPIDEMIOLOGY/TRANSMISSION
Male Middle East/EPIDEMIOLOGY Risk Factors Sex Behavior MEETING
ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).