Sexual behavior, heterosexual transmission, and the spread of HIV in sub-Saharan Africa: a simulation study.
A stochastic simulation model has been used to assess the extent to which variation in sexual behavior and transmission characteristics can explain the striking spatial heterogeneity in the prevalence of HIV among different geographical locations in sub-Saharan Africa. Of the various parameters describing sexual behavior the most important determinant of the spread of HIV is the proportion of men engaging in sexual relationships with people other than spouses, including contacts with sex workers and short-term partners. Considering factors other than sexual behavior the model shows that this heterogeneity in HIV prevalence could be the result of differences in the transmission probability of HIV or in the prevalence of other sexuality transmitted diseases. These factors could play a key role in determining the patterns of spread of HIV in sub-Saharan Africa and should be considered in the design of intervention strategies.
Auvert
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INSERM U88, 14 rue du Val d'Osne, Saint-Maurice Cedex, 94415, France.
Buonamico
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Lagarde
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Williams
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D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D003198:Computer Simulation; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology / Q000635:transmission*; D020010:Heterosexuality; D006801:Humans; D008297:Male; D009010:Monte Carlo Method; D012309:Risk-Taking; D012725:Sexual Behavior; D012747:Sexual Partners; D013269:Stochastic Processes