Academic journal article Bulletin of the World Health Organization

Focusing Strategies of Condom Use against HIV in Different Behavioural Settings: An Evaluation Based on a Simulation Model(*)

Academic journal article Bulletin of the World Health Organization

Focusing Strategies of Condom Use against HIV in Different Behavioural Settings: An Evaluation Based on a Simulation Model(*)

Article excerpt

Using a sexually transmitted diseases simulation model (STDSIM), we made projections of HIV spread for four profiles of sexual behaviour reflecting patterns encountered across the developing world: 1) much commercial sex, no short relationships; 2) commercial sex, concurrent short relationships; 3) concurrent relationships, no commercial sex; 4) serial short relationships, some commercial sex. We studied the effects of increasing condom use in three target groups: commercial sex workers (CSWs); men engaging in commercial contacts and short relationships; and females in steady relationships. The projections indicated that the CSW and male strategies were more effective in reducing HIV incidence than the strategy focusing on females in steady relationships. In the long run, even the group of men and women with one recent partner were better protected against HIV infection by condom use in high-risk contacts than by condom use in steady relationships. Furthermore, the numbers of HIV cases prevented per condom used were 7 to 500 times higher for condoms used by CSWs or men engaging in short relationships and commercial sex than for ones used by females in steady relationships. The results indicated the merit of focusing on high-risk groups irrespective of the pattern of sexual behaviour, even in epidemics that had already spread throughout populations.

Keywords Condoms/utilization; HIV infections/transmission/prevention and control; Sex behavior; Prostitution; Risk factors; Men; Women; Forecasting/methods; Stochastic processes; Developing countries (source: MeSH).

Mots cles Condom/utilisation; HIV, Infection/transmission/prevention et controle; Comportement sexuel; Prostitution; Facteur risque; Hommes; Femmes; Prevision/methodes; Processus stochastique; Pays en development (source: INSERM).

Palabras clave Condones/utilizacion; Infecciones por VIH/transmision/prevencion y control; Conducta sexual; Prostitucion; Factores de riesgo; Hombres; Mujeres; Prediccion/metodos; Procesos estocasticos; Paises en desarrollo (fuente: BIREME).

Bulletin of the World Health Organization, 2001, 79: 442-454.

Voir page 452 le resume en francais. En la pagina 453 figura un resumen en espanol.

Introduction

HIV/AIDS continues to spread rapidly in many developing countries, in parts of southern Africa the prevalence of HIV in the general population exceeds 30%; high incidence rates have also been reported from parts of South-East Asia (1). In most countries in these regions, vaccination and affordable effective treatment are unlikely to be available for many years. Preventive measures are therefore the only realistic option for control. Over 90% of adult cases in developing countries are attributable to heterosexual activity (2) and it is therefore vital to prevent this mode of transmission. It is important to consider whether and to what extent special efforts should be made to reach specific groups in populations in order to develop strategies for the prevention of HIV.

Sexual behaviour patterns vary widely between countries (3) and there may be large differences in sexual norms and practices between different groups within countries. Mathematical models have shown that heterogeneity in sexual behaviour within a population (4, 5) and the extent of concurrency in sexual relationships (6, 7) are important determinants for the spread of HIV and other sexually transmitted diseases (STDs). Modelling exercises have also shown that interventions focused on groups at high risk of contracting and transmitting HIV are more effective and more cost-effective than interventions aimed at the general population (2, 5, 8, 9). However, this finding has not been studied in more realistic behavioural settings.

In the present paper we discuss the value of focusing interventions on particular groups in a population in different behavioural settings with diverging HIV epidemics. We present model projections of the impact of three differently focused strategies of condom use, using a framework described earlier in a policy research report on AIDS (10). …

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