Search

BackgroundKey components of Ending the HIV Epidemic (EHE) plan include increasing HIV antiretroviral therapy (ART) and HIV pre-exposure prophylaxis (PrEP) coverage. One complication to addressing this service delivery challenge is the wide heterogeneity of HIV burden and health care access across the United States. It is unclear how the effectiveness and efficiency of expanded PrEP will depend on different baseline ART coverage.MethodsWe used a network-based model of HIV transmission for men who have sex with men (MSM) in San Francisco. Model scenarios increased varying levels of PrEP coverage relative under current empirical levels of baseline ART coverage and 2 counterfactual levels. We assessed the effectiveness of PrEP with the cumulative percentage of infections averted (PIA) over the next decade and efficiency with the number of additional person-years needed to treat (NNT) by PrEP required to avert one HIV infection.ResultsIn our projections, only the highest levels of combined PrEP and ART coverage achieved the EHE goals. Increasing PrEP coverage up to 75% showed that PrEP effectiveness was higher at higher baseline ART coverage. Indeed, the PIA was 61% in the lowest baseline ART coverage population and 75% in the highest. The efficiency declined with increasing ART (NNT range from 41 to 113).ConclusionsImproving both PrEP and ART coverage would have a synergistic impact on HIV prevention even in a high baseline coverage city such as San Francisco. Efforts should focus on narrowing the implementation gaps to achieve higher levels of PrEP retention and ART sustained viral suppression.

[ES] Desde tiempos inmemorables en la historia de la humanidad las enfermedades de transmisión sexual (ETSs) han sido una gran amenaza para la salud pública. Las preocupaciones comienzan en la edad moderna con pandemias tales como la sífilis, cuya propagación ocurre en Europa a comienzos del siglo XVI. El virus de papiloma humano (VPH) es la causa directa de más de medio millón de casos nuevos de cáncer de cuello de útero, el segundo más maligno entre mujeres y una de las principales causas de muerte por cáncer en todo el mundo. Además causa verrugas anogenitales y otras enfermedades relacionadas. En este trabajo estudiamos el contagio del VPH en una red de contactos sexuales. Para predecir la evolución de este tipo de enfermedades, necesitamos un modelo fiable de la red social subyacente sobre el que la infección prolifera. Hemos construido una red de parejas sexuales durante toda la vida basada en datos demográficos y encuestas sobre hábitos sexuales. La mayoría de los enfoques para modelizar ETSs por lo general y del VPH en particular, se hacen usando modelos clásicos donde la hipótesis de mezcla homogénea (todo el mundo puede transmitir a todo el mundo) es asumida de manera implícita. Sin embargo, la mezcla homogénea no es una hipótesis razonable y las consecuencias de estas suposiciones se ven de hecho, en que los efectos de los calendarios de vacunación contra el VPH se detectan en Australia mucho antes de lo que los modelos clásicos predijeron. Hay un debate sobre la conveniencia de la vacunación de los niños. Elbasha et al. encontraron evidencias de que la vacunación en niños podría llegar a ser coste-efectiva. En nuestro modelo consideramos poblaciones tanto de hombres que solo tienen relaciones con mujeres y que las tienen entre ellos, permitiéndonos sacar conclusiones al respecto. Con nuestro modelo simulamos y llevamos a cabo campañas de vacunación de modo que podemos sacar conclusiones atendiendo a las mejores estrategias. Estos resultados pueden ayudar, [CA] Des de temps inmemorables en la història de la humanitat les malalties de transmissió sexual (MTSs) han sigut una gran amenaça per a la salut pública. Les preocupacions comencen en l'edat moderna amb pandèmies com ara la sífilis, la propagació de la qual ocorre a Europa al començament del segle XVI. El virus de papilloma humà (VPH) és el causant directe de més de mig milió de casos nous de càncer de coll d'úter, el segon mes maligne entre dones i una de les principals causes de mort per càncer en tot el món. A més causa berrugues anogenitales i altres malalties relacionades. En este treball estudiem la dinàmica de transmissió del VPH en una xarxa de contactes sexuals. Per a predir l'evolució d'este tipus de malalties, necessitem un model fiable de la xarxa social subjacent sobre la qual la infecció prolifera. Hem construït un xarxa de parelles sexuals durant tota la vida basada en dades demogràfiques i enquestes sobre hàbits sexuals. La majoria dels enfocaments per a modelizar MTSs generalment i del VPH en particular, es fan usant models clàssics on la hipótesi de mescla homogènia (tot el món pot transmetre a tot el món) és assumida de manera implícita. No obstant això la mescla homogènia no és una hipòtesi raonable i les conseqüències d'estes suposicions es veuen de fet, en que els efectes dels calendaris de vacunació contra el VPH es detecten a Austràlia molt abans del que els models clàssics van predir., [EN] Sexually transmitted diseases (STDs) have been a major public health threat for a long time in human history. Modern concerns about STD began with the pandemic of syphilis which spread over Europe in the early sixteenth century. The human papillomavirus (HPV) is the direct cause of more than half million new cases of cervical cancer, the second most common malignancy among women and a leading cause of cancer death worldwide. It also causes anogenital warts and other related diseases. In this work we have studied the transmission dynamics of HPV over a sexual contacts network. In order to predict the evolution of these kind of diseases, we need a reliable model of the underlying social network in which the infection spreads. We have built a lifetime sexual partners (LSP) network based on demographic data and surveys about sexual habits. Most of the modeling approaches to STD in general and HPV in particular, are done using classical models where the hypothesis of homogeneous mixing (everybody can transmit a disease to everybody) is assumed. However, homogeneous mixing is not a reasonable hypothesis and consequences of this assumption can be seen, for instance, in that the effects of vaccination schedules against HPV have been detected in Australia much sooner than what the classical models predicted. There is a debate concerning the vaccination of young men. Elbasha et al. found some evidences that the vaccination of boys could also be cost-effective. In our model we consider both heterosexual men, and men who have sex with men (MSM) populations and the connections among them letting us to study this matter. With our model simulate and carry out vaccination campaigns in order to figure out the best strategies. All these results can be useful for policy makers in Public Health to make appropriate decisions respect to HPV.

[ES] Desde tiempos inmemorables en la historia de la humanidad las enfermedades de transmisión sexual (ETSs) han sido una gran amenaza para la salud pública. Las preocupaciones comienzan en la edad moderna con pandemias tales como la sífilis, cuya propagación ocurre en Europa a comienzos del siglo XVI. El virus de papiloma humano (VPH) es la causa directa de más de medio millón de casos nuevos de cáncer de cuello de útero, el segundo más maligno entre mujeres y una de las principales causas de muerte por cáncer en todo el mundo. Además causa verrugas anogenitales y otras enfermedades relacionadas. En este trabajo estudiamos el contagio del VPH en una red de contactos sexuales. Para predecir la evolución de este tipo de enfermedades, necesitamos un modelo fiable de la red social subyacente sobre el que la infección prolifera. Hemos construido una red de parejas sexuales durante toda la vida basada en datos demográficos y encuestas sobre hábitos sexuales. La mayoría de los enfoques para modelizar ETSs por lo general y del VPH en particular, se hacen usando modelos clásicos donde la hipótesis de mezcla homogénea (todo el mundo puede transmitir a todo el mundo) es asumida de manera implícita. Sin embargo, la mezcla homogénea no es una hipótesis razonable y las consecuencias de estas suposiciones se ven de hecho, en que los efectos de los calendarios de vacunación contra el VPH se detectan en Australia mucho antes de lo que los modelos clásicos predijeron. Hay un debate sobre la conveniencia de la vacunación de los niños. Elbasha et al. encontraron evidencias de que la vacunación en niños podría llegar a ser coste-efectiva. En nuestro modelo consideramos poblaciones tanto de hombres que solo tienen relaciones con mujeres y que las tienen entre ellos, permitiéndonos sacar conclusiones al respecto. Con nuestro modelo simulamos y llevamos a cabo campañas de vacunación de modo que podemos sacar conclusiones atendiendo a las mejores estrategias. Estos resultados pueden ayudar, [CA] Des de temps inmemorables en la història de la humanitat les malalties de transmissió sexual (MTSs) han sigut una gran amenaça per a la salut pública. Les preocupacions comencen en l'edat moderna amb pandèmies com ara la sífilis, la propagació de la qual ocorre a Europa al començament del segle XVI. El virus de papilloma humà (VPH) és el causant directe de més de mig milió de casos nous de càncer de coll d'úter, el segon mes maligne entre dones i una de les principals causes de mort per càncer en tot el món. A més causa berrugues anogenitales i altres malalties relacionades. En este treball estudiem la dinàmica de transmissió del VPH en una xarxa de contactes sexuals. Per a predir l'evolució d'este tipus de malalties, necessitem un model fiable de la xarxa social subjacent sobre la qual la infecció prolifera. Hem construït un xarxa de parelles sexuals durant tota la vida basada en dades demogràfiques i enquestes sobre hàbits sexuals. La majoria dels enfocaments per a modelizar MTSs generalment i del VPH en particular, es fan usant models clàssics on la hipótesi de mescla homogènia (tot el món pot transmetre a tot el món) és assumida de manera implícita. No obstant això la mescla homogènia no és una hipòtesi raonable i les conseqüències d'estes suposicions es veuen de fet, en que els efectes dels calendaris de vacunació contra el VPH es detecten a Austràlia molt abans del que els models clàssics van predir., [EN] Sexually transmitted diseases (STDs) have been a major public health threat for a long time in human history. Modern concerns about STD began with the pandemic of syphilis which spread over Europe in the early sixteenth century. The human papillomavirus (HPV) is the direct cause of more than half million new cases of cervical cancer, the second most common malignancy among women and a leading cause of cancer death worldwide. It also causes anogenital warts and other related diseases. In this work we have studied the transmission dynamics of HPV over a sexual contacts network. In order to predict the evolution of these kind of diseases, we need a reliable model of the underlying social network in which the infection spreads. We have built a lifetime sexual partners (LSP) network based on demographic data and surveys about sexual habits. Most of the modeling approaches to STD in general and HPV in particular, are done using classical models where the hypothesis of homogeneous mixing (everybody can transmit a disease to everybody) is assumed. However, homogeneous mixing is not a reasonable hypothesis and consequences of this assumption can be seen, for instance, in that the effects of vaccination schedules against HPV have been detected in Australia much sooner than what the classical models predicted. There is a debate concerning the vaccination of young men. Elbasha et al. found some evidences that the vaccination of boys could also be cost-effective. In our model we consider both heterosexual men, and men who have sex with men (MSM) populations and the connections among them letting us to study this matter. With our model simulate and carry out vaccination campaigns in order to figure out the best strategies. All these results can be useful for policy makers in Public Health to make appropriate decisions respect to HPV.

Short-term mobility can significantly influence the spread of infectious disease. In order for mobile individuals to geographically spread sexually transmitted infections (STIs), individuals must engage in sexual acts with different partners in two places within a short time. In this study, we considered the potential of mobile individuals as bridge populations - individuals who link otherwise disconnected sexual networks and contributed to ongoing STI transmission. Using monthly retrospective panel data, we examined associations between short-term mobility and sexual partner concurrency in Agbogbloshie, Ghana. We also examined bridging by the location of sex acts and the location of sexual partners in concurrent triads, and whether mobile individuals from our sample were more likely to be members of geographic bridging triads. Although reported rates of sexual partnership concurrency were much higher for men compared to women, mobility was only associated with increased concurrency for women. Additionally, this association held for middle-distance mobility and short-duration trips for women. Taking into account the location of sex acts and the location of sexual partners, about 22% of men (21.7% and 22.4% for mobile and non-mobile men, respectively) and only 3% of women (1.4% and 3.3% for mobile and non-mobile women, respectively) were potential bridges for STIs over the last year. Our results highlight the gendered nature of mobility and sexual risk behavior, reflecting the normative social context that encourages women to conceal certain types of sexual behavior.

Since the beginning of the HIV/AIDS epidemic, the perspectives of secondary and tertiary school graduates in sub-Saharan Africa regarding the effectiveness of government and international HIV/AIDS policies and programmes have not been thoroughly examined. When extensive monetary aid is directed toward "development" in a country like Malawi, it is the educated elites - secondary and tertiary graduates who are heavily involved and influential in the domestic re-distribution and implementation of millions of dollars worth of aid - on whom international expectations fall to decrease the transmission of HIV. Many Malawian jobs related to public health and HIV/AIDS are created as a direct result of this funding and are occupied by the few secondary and tertiary graduates. Thus, it is a practical venture to understand their perspectives on highly contentious and heavily funded HIV/AIDS issues that affect their nation. Qualitative data was collected in this study in efforts to discover in-depth perspectives on the HIV/AIDS epidemic. Thirty-eight secondary and tertiary graduate Malawians took part in semi-structured interviews. Data was analysed using an early grounded theory approach and subsequent themes of "global discourses" and "experiential knowledge of HIV/AIDS" emerged. This group of Malawians frequently responded to questions regarding healthcare and access to medicine, sexual behaviours and methods of reducing the spread of HIV/AIDS by citing and explaining the widespread, international and "proper" responses. The secondary and tertiary graduate Malawians also discussed these same topics in terms of what they perceive or have experienced. Experiential responses, such as the counter-productivity of circumcision and condoms, the overestimation of HIV/AIDS prevalence, and calls for more authoritarian policing of commercial sex work, were remarkably divergent from the HIV/AIDS discourse. The opinions of this group of secondary and tertiary graduate Malawians do not alw

Like many other social phenomena, prostitution is increasingly coordinated over the Internet. The online behavior affects the offline activity; the reverse is also true. We investigated the reported sexual contacts between 6,624 anonymous escorts and 10,106 sex buyers extracted from an online community from its beginning and six years on. These sexual encounters were also graded and categorized (in terms of the type of sexual activities performed) by the buyers. From the temporal, bipartite network of posts, we found a full feedback loop in which high grades on previous posts affect the future commercial success of the sex worker, and vice versa. We also found a peculiar growth pattern in which the turnover of community members and sex workers causes a sublinear preferential attachment. There is, moreover, a strong geographic influence on network structure—the network is geographically clustered but still close to connected, the contacts consistent with the inverse-square law observed in trading patterns. We also found that the number of sellers scales sublinearly with city size, so this type of prostitution does not, comparatively speaking, benefit much from an increasing concentration of people.