Objective: To examine how concurrent partnerships amplify the rate of HIV spread, using methods that can be supported by feasible data collection.
Methods: A fully stochastic simulation is used to represent a population of individuals, the sexual partnerships that they form and dissolve over time, and the spread of an infectious disease. Sequential monogamy is compared with various levels of concurrency, holding all other features of the infection process constant. Effective summary measures of concurrency are developed that can be estimated on the basis of simple local network data.
Results: Concurrent partnerships exponentially increase the number of infected individuals and the growth rate of the epidemic during its initial phase. For example, when one-half of the partnerships in a population are concurrent, the size of the epidemic after 5 years is 10 times as large as under sequential monogamy. The primary cause of this amplification is the growth in the number of people connected in the network at any point in time: the size of the largest ‘component’. Concurrency increases the size of this component, and the result is that the infectious agent is no longer trapped in a monogamous partnership after transmission occurs, but can spread immediately beyond this partnership to infect others. The summary measure of concurrency developed here does a good job in predicting the size of the amplification effect, and may therefore be a useful and practical tool for evaluation and intervention at the beginning of an epidemic.
Conclusion: Concurrent partnerships may be as important as multiple partners or cofactor infections in amplifying the spread of HIV. The public health implications are that data must be collected properly to measure the levels of concurrency in a population, and that messages promoting ‘one partner at a time’ are as important as messages promoting fewer partners.
1The Department of Sociology, Pennsylvania State University, University Park, Pennsylvania, USA
2The National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands.
3Requests for reprints to: Martina Morris, Department of Sociology, Pennsylvania State University, 614 Oswald Tower, University Park PA 16802–6211, USA.
Sponsorship: Supported by the Rockefeller Foundation, National Institutes of Health (1R29HD34957-01).
Date of receipt: 6 June 1996; revised: 22 November 1996; accepted: 15 January 1997.
[For editorial comment see pp681–683]