The role of acute-stage transmission in sustaining HIV epidemics has been difficult to determine. This difficulty is exacerbated by a lack of theoretical understanding of how partnership dynamics and sexual behavior interact to affect acute-stage transmission. We propose that individual-level variation in rates of sexual contact is a key aspect of partnership dynamics that can greatly increase acute-stage HIV transmission.
Using an individual-based stochastic framework, we simulated a model of HIV transmission that includes individual-level changes in contact rates. We report both population-level statistics (such as prevalence and acute-stage transmission rates) and individual-level statistics (such as the contact rate at the time of infection).
Volatility increases both the prevalence of HIV and the proportion of new cases from acute-stage infectors. These effects result from 1) a relative reduction in transmission rate from chronic but not acute infectors and 2) an increase in the availability of high-risk susceptibles.
The extent of changes in individual-level contact rates in the real world is unknown. Aggregate or strictly cross-sectional data do not reveal individual-level changes in partnership dynamics and sexual behavior. The strong effects presented in this article motivate both continued theoretical exploration of volatility in sexual behavior and collection of longitudinal individual-level data to inform more realistic models.
Supplemental Digital Content is available in the text.
From the Department of Epidemiology, University of Michigan, Ann Arbor, MI.
Supported by NIH R01-AI078752. E.V. was also supported by NIH 1-K01-AI-091440-01.
Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com). This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.
Correspondence: Ethan Obie Romero-Severson, Department of Epidemiology, University of Michigan, 335 E Kingsley #2, Ann Arbor, MI 48104. E-mail: firstname.lastname@example.org.
Received November 14, 2011
Accepted January 31, 2013