title: Modeling HIV transmission risk among Mozambicans prior to their initiating highly active antiretroviral therapy.
abstract: Understanding sexual behavior and assessing transmission risk among people living with HIV-1 is crucial for effective HIV-1 prevention. We describe sexual behavior among HIV-positive persons initiating highly active antiretroviral therapy (HAART) in Beira, Mozambique. We present a Bernoulli process model (tool available online) to estimate the number of sexual partners who would acquire HIV-1 as a consequence of sexual contact with study participants within the prior three months. Baseline data were collected on 350 HAART-naive individuals 18-70 years of age from October 2004 to February 2005. In the three months prior to initiating HAART, 45% (n = 157) of participants had sexual relationships with 191 partners. Unprotected sex occurred in 70% of partnerships, with evidence suggesting unprotected sex was less likely with partners believed to be HIV-negative. Only 26% of the participants disclosed their serostatus to partners with a negative or unknown serostatus. Women were less likely to report concurrent relationships than were men (21 versus 66%; OR 0.13; 95%CI: 0.06, 0.26). Given baseline behaviors, the model estimated 23.2 infections/1,000 HIV-positive persons per year. The model demonstrated HAART along with syphilis and herpes simplex virus type 2 (HSV-2) treatment combined could reduce HIV-1 transmission by 87%; increasing condom use could reduce HIV-1 transmission by 67%.
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, WA 98105-1525, USA. pearsonc@u.washington.edu
authors.forename: C R
authors.initials: CR
authors.lastname: Pearson
authors.forename: A E
authors.initials: AE
authors.lastname: Kurth
authors.forename: S
authors.initials: S
authors.lastname: Cassels
authors.forename: D P
authors.initials: DP
authors.lastname: Martin
authors.forename: J M
authors.initials: JM
authors.lastname: Simoni
authors.forename: P
authors.initials: P
authors.lastname: Hoff
authors.forename: E
authors.initials: E
authors.lastname: Matediana
authors.forename: S
authors.initials: S
authors.lastname: Gloyd
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D015995:Prevalence; D012725:Sexual Behavior / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data