Sexual behavior, risk perception, and HIV transmission can respond to HIV antiviral drugs and vaccines through multiple pathways.
There has been growing use of highly active antiretroviral treatment (HAART) for HIV and significant progress in developing prophylactic HIV vaccines. The simplest theories of counterproductive behavioral responses to such interventions tend to focus on single feedback mechanisms: for instance, HAART optimism makes infection less scary and thus promotes risky sexual behavior. Here, we develop an agent based, age-structured model of HIV transmission, risk perception, and partner selection in a core group to explore behavioral responses to interventions. We find that interventions can activate not one, but several feedback mechanisms that could potentially influence decision-making and HIV prevalence. In the model, HAART increases the attractiveness of unprotected sex, but it also increases perceived risk of infection and, on longer timescales, causes demographic impacts that partially counteract HAART optimism. Both HAART and vaccination usually lead to lower rates of unprotected sex on the whole, but intervention effectiveness depends strongly on whether individuals over- or under-estimate intervention coverage. Age-specific effects cause sexual behavior and HIV prevalence to change in opposite ways in old and young age groups. For complex infections like HIV-where interventions influence transmission, demography, sexual behavior and risk perception-we conclude that evaluations of behavioral responses should consider multiple feedback mechanisms.
Department of Mathematics and Statistics University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1 Canada.
Stephen
S
Tully
Department of Mathematics and Statistics University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1 Canada.
Monica
M
Cojocaru
Department of Mathematics and Statistics University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1 Canada.|Department of Applied Mathematics University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1 Canada.
Chris T
CT
Bauch
D016915:AIDS Vaccines; D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018562:Disease Transmission, Infectious; D006678:HIV / Q000276:immunology*; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology / Q000635:transmission*; D006801:Humans; D008875:Middle Aged; D008954:Models, Biological; D015995:Prevalence; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D055815:Young Adult
D016915:AIDS Vaccines; D019380:Anti-HIV Agents