Concurrent Sexual Partnerships and Primary HIV Infection: A Critical Interaction

The combination of long-term concurrent sexual partnerships and high infectiousness early in HIV infection has been suggested as a key driver of the extensive spread of HIV in general populations in sub-Saharan Africa, but this has never been scientifically investigated. We use a mathematical model to simulate HIV spreading on sexual networks with different amounts of concurrency. The models show that if HIV infectiousness is constant over the duration of infection, the amount of concurrency has much less influence on HIV spread compared to when infectiousness varies over three stages of infection with high infectiousness in the first months. The proportion of transmissions during primary infection is sensitive to the amount of concurrency and, in this model, is estimated to be between 16 and 28% in spreading epidemics with increasing concurrency. The sensitivity of epidemic spread to the amount of concurrency is greater than predicted by models that do not include primary HIV infection.

[1]  J. Shelton.  A tale of two-component generalised HIV epidemics , 2010, The Lancet.

[2]  Martina Morris,et al.  Concurrent Partnerships and Trans-mission Dynamics in Networks , 1995 .

[3]  and Projections Working Group on Measuring Concurrent Modelling.  HIV: consensus indicators are needed for concurrency , 2010, The Lancet.

[4]  H. Epstein,et al.  Concurrent sexual partnerships help to explain Africa's high HIV prevalence: implications for prevention , 2004, The Lancet.

[5]  M Kretzschmar,et al.  Measures of concurrency in networks and the spread of infectious disease. , 1996, Mathematical biosciences.

[6]  Christopher Dye,et al.  Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model , 2009, The Lancet.

[7]  Steven D. Pinkerton,et al.  Probability of HIV Transmission During Acute Infection in Rakai, Uganda , 2008, AIDS and Behavior.

[8]  Ira M Longini,et al.  No HIV stage is dominant in driving the HIV epidemic in sub-Saharan Africa , 2008, AIDS.

[9]  Christopher D Pilcher,et al.  Brief but efficient: acute HIV infection and the sexual transmission of HIV. , 2004, The Journal of infectious diseases.

[10]  H. Epstein,et al.  The Mathematics of Concurrent Partnerships and HIV: A Commentary on Lurie and Rosenthal, 2009 , 2010, AIDS and Behavior.

[11]  S M Pollock,et al.  The role of early HIV infection in the spread of HIV through populations. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[12]  G. Garnett,et al.  Coining a new term in epidemiology: concurrency and HIV. , 1997, AIDS.

[13]  W. Miller,et al.  Rapid, real-time detection of acute HIV infection in patients in Africa. , 2007, The Journal of infectious diseases.

[14]  Richard J Hayes,et al.  Amplified HIV transmission during early-stage infection. , 2006, The Journal of infectious diseases.

[15]  Martina Morris,et al.  A microsimulation study of the effect of concurrent partnerships on the spread of HIV in Uganda , 2000 .

[16]  M. Morris,et al.  Concurrent partnerships and syphilis persistence: new thoughts on an old puzzle. , 2001, Sexually transmitted diseases.

[17]  R M May,et al.  The influence of concurrent partnerships on the dynamics of HIV/AIDS. , 1992, Mathematical biosciences.

[18]  Marie-Claude Boily,et al.  Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. , 2009, The Lancet. Infectious diseases.

[19]  Daniel T. Halperin,et al.  Concurrent Sexual Partnerships and the HIV Epidemics in Africa: Evidence to Move Forward , 2010, AIDS and Behavior.

[20]  C. Hudson,et al.  Concurrent Partnerships Could Cause AIDS Epidemics , 1993, International journal of STD & AIDS.

[21]  M. Kretzschmar,et al.  Concurrent partnerships and the spread of HIV , 1997, AIDS.

[22]  K Dietz,et al.  The effect of pair formation and variable infectivity on the spread of an infection without recovery. , 1998, Mathematical biosciences.

[23]  R. Hayes,et al.  Proportion of HIV infections attributable to other sexually transmitted diseases in a rural Ugandan population: simulation model estimates. , 1997, International journal of epidemiology.

[24]  Mirjam Kretzschmar,et al.  Primary HIV infection as source of HIV transmission within steady and casual partnerships among homosexual men , 2004, AIDS.

[25]  J. Heesterbeek,et al.  The basic reproduction ratio for sexually transmitted diseases. Part 2. Effects of variable HIV infectivity. , 1993, Mathematical biosciences.

[26]  Constance A Nyamukapa,et al.  HIV Decline Associated with Behavior Change in Eastern Zimbabwe , 2006, Science.

[27]  O. Laeyendecker,et al.  Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. , 2005, The Journal of infectious diseases.

[28]  R. Anderson,et al.  Factors controlling the spread of HIV in heterosexual communities in developing countries: patterns of mixing between different age and sexual activity classes. , 1993, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[29]  Charles Poole,et al.  Rethinking the heterosexual infectivity of HIV-1: a systematic review and meta-analysis. , 2008, The Lancet. Infectious diseases.

[30]  Christophe Fraser,et al.  HIV-1 transmission, by stage of infection. , 2008, The Journal of infectious diseases.

[31]  R. Anderson,et al.  For Personal Use. Only Reproduce with Permission from the Lancet Publishing Group , 2022 .

[32]  Samantha Rosenthal,et al.  Concurrent Partnerships as a Driver of the HIV Epidemic in Sub-Saharan Africa? The Evidence is Limited , 2010, AIDS and Behavior.

[33]  M. Morris.  Barking up the Wrong Evidence Tree. Comment on Lurie & Rosenthal, “Concurrent Partnerships as a Driver of the HIV Epidemic in Sub-Saharan Africa? The Evidence is Limited” , 2009, AIDS and Behavior.

[34]  J. Shelton.  Why multiple sexual partners? , 2009, The Lancet.