MSM Computer Orientation PowerSchool MSM Web Page SchoolFusion/Class Pages.
Behavioral, Biological and Structural Components of MSM STI Morbidity Steven Goodreau and Matthew...
-
Upload
bruno-mcgee -
Category
Documents
-
view
213 -
download
0
Transcript of Behavioral, Biological and Structural Components of MSM STI Morbidity Steven Goodreau and Matthew...
Behavioral, Biological and StructuralComponents of MSM STI Morbidity
Steven Goodreau and Matthew GoldenUniversity of Washington CFAR
HIV/AIDS in MSM
2002 Diagnoses of HIV/AIDS, by exposure category
Source: CDC HIV/AIDS Surveillance Report Vol. 14, 2002
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000
Male-to-male sexual contact
Heterosexual contact - females
Heterosexual contact - male
IDU - Males
IDU - females
Male-to-male sexual contact & IDU
Perinatal
Why?
Behavioral explanations:
•Numbers of partners•Condom use
Why?
Behavioral explanations:
•Numbers of partners•Condom use
Biological explanations:
•Transmissibility
Why?
Behavioral explanations:
•Numbers of partners•Condom use
Biological explanations:
•Transmissibility
Structural explanations:
•Two-sex vs. one sex•Population size•Versatility•Assortative mixing
Thought experiment
How large a difference in epidemics might occur between MSM and heterosexual populations that are
identical in behavioral characteristics, but
differ in structural and biological characteristics?
Explore using a mathematical model and data on MSM sexual behavior from UMHS (1995).
Partners in past twelve months
All males: NHSLS (random sample of US adults)MSM: UMHS (random sample of MSM in four large US cities)
0
10
20
30
40
50
60
70
80
all males - anysex
% with 0 partners
% with 1 partner
% with 2+ partners
Median = 1
Partners in past twelve months
All males: NHSLS (random sample of US adults)MSM: UMHS (random sample of MSM in four large US cities)
0
10
20
30
40
50
60
70
80
all males - anysex
MSM - any sex
% with 0 partners
% with 1 partner
% with 2+ partners
Median = 1 Median = 3Mean = 10.9
Partners in past twelve months
All males: NHSLS (random sample of US adults)MSM: UMHS (random sample of MSM in four large US cities)
0
10
20
30
40
50
60
70
80
all males - anysex
MSM - any sex MSM - anal sex
% with 0 partners
% with 1 partner
% with 2+ partners
Median = 1 Median = 3Mean = 10.9
Median = 1Mean = 4.0
Partners in past twelve months
All males: NHSLS (random sample of US adults)MSM: UMHS (random sample of MSM in four large US cities)
Median = 0Mean = 1.3
0
10
20
30
40
50
60
70
80
all males - anysex
MSM - any sex MSM - anal sex MSM - unprot.anal
% with 0 partners
% with 1 partner
% with 2+ partners
Median = 1 Median = 3Mean = 10.9
Median = 1Mean = 4.0
Model basics
Sero- negative
Subdivided into compartments based on:
Activity level
No activityLow activityHigh activity
Sero- positive
Role
Insertive (male)Receptive (female)
VersatileInsertiveReceptive
Deterministic Compartmental
heterosexual pop.
MSM pop.
Model features
•Activity levels: none 62.8%low (1 partner per year)
15.5 %high (7.7 partners per year)
21.7 %
•Roles: MSM: heterosexuals:
versatile 50% insertive 50%
insertive 35% receptive 50%
receptive 15%
•Mixing by level: 16.6 times more likely to choose partners of the same activity level than expected by chance
UMHS
UMHS
NHSLS
Sources:
Model features
Transmissibility/ unprot. receptive anal 0.00500act: unprot. insertive anal 0.00065
unprot. receptive vaginal 0.00100unprot. insertive vaginal 0.00050
Acts/ 10 (for high-high)partnership: 50 (for high-low)
250 (for low-low)
•Size: small = 1,000; large = 10,000
•Removals: sero-ves: 30 years after entrysero+ves: 7.5 years after
seroconversion
•Arrivals: equal in number to removals
Vargheseet al. 1992
UMHS
Sources:
0
0.05
0.1
0.15
0.2
0.25
0 25 50 75 100 125 150
year
HIV
pre
va
len
ce
Results - HIV prevalence
MSM - all versatilesmall pop, anal transmissibility
0
0.05
0.1
0.15
0.2
0.25
0 25 50 75 100 125 150
year
HIV
pre
va
len
ce
Results - HIV prevalence
MSM - all versatilesmall pop, anal transmissibility
Heterosexual or MSM-no versatilesmall pop, anal transmissibility
0
0.05
0.1
0.15
0.2
0.25
0 25 50 75 100 125 150
year
HIV
pre
va
len
ce
Results - HIV prevalence
MSM - all versatilesmall pop, anal transmissibility
MSM – observed versatilitysmall pop, anal transmissibility
Heterosexual or MSM-no versatilesmall pop, anal transmissibility
0
0.05
0.1
0.15
0.2
0.25
0 25 50 75 100 125 150
year
HIV
pre
va
len
ce
Results - HIV prevalence
MSM - all versatilesmall pop, anal transmissibility
MSM – observed versatilitysmall pop, anal transmissibility
Heterosexuallarge pop, anal transmissibility
Heterosexual or MSM-no versatilesmall pop, anal transmissibility
0
0.05
0.1
0.15
0.2
0.25
0 25 50 75 100 125 150
year
HIV
pre
va
len
ce
Results –HIV prevalence
Heterosexuallarge pop, vaginal transmissibility
MSM - all versatilesmall pop, anal transmissibility
MSM – observed versatilitysmall pop, anal transmissibility
Heterosexuallarge pop, anal transmissibility
Heterosexual or MSM-no versatilesmall pop, anal transmissibility
Results (cont.)
In order to have the same HIV prevalence as MSM after the first 20 years of the epidemic, heterosexuals would need to have 4.4 times as many partners as MSM on average.
Results (cont.)
MSM are more susceptible to high risk behavior by a small subset of the population.
Results (cont.)
MSM are more susceptible to high risk behavior by a small subset of the population.
If the partnering rates of the high-activity group are doubled:
Results (cont.)
MSM are more susceptible to high risk behavior by a small subset of the population.
If the partnering rates of the high-activity group are doubled:
0%
200%
400%
600%
800%
1000%
1200%
0 5 10 15 20
year
ch
an
ge
in H
IV p
rev
ale
nc
e
co
mp
are
d t
o o
bs
erv
ed
ac
tiv
ity
le
ve
ls
prevalence at year 20 of the epidemic is changed by
975% in MSM 170% in heterosexuals
MSM
Het
Implications
•Structural and biological factors can play major roles in increasing susceptibility of MSM populations to HIV.
Implications
•Structural and biological factors can play major roles in increasing susceptibility of MSM populations to HIV.
•The public health community should not assume that persistent differences in HIV/STD levels between MSM and heterosexuals are due only (or even primarily) to differences in individual behavior.
Implications
•Structural and biological factors can play major roles in increasing susceptibility of MSM populations to HIV.
•The public health community should not assume that persistent differences in HIV/STD levels between MSM and heterosexuals are due only (or even primarily) to differences in individual behavior.
•MSM will remain relatively vulnerable to HIV/STD epidemics even with major shifts in behavior.
Implications
•Structural and biological factors can play major roles in increasing susceptibility of MSM populations to HIV.
•The public health community should not assume that persistent differences in HIV/STD levels between MSM and heterosexuals are due only (or even primarily) to differences in individual behavior.
•MSM will remain relatively vulnerable to HIV/STD epidemics even with major shifts in behavior.
•What about Africa? higher infectivity other structural patterns not modeled herenosocomial
Implications
•Structural and biological factors can play major roles in increasing susceptibility of MSM populations to HIV.
•The public health community should not assume that persistent differences in HIV/STD levels between MSM and heterosexuals are due only (or even primarily) to differences in individual behavior.
•MSM will remain relatively vulnerable to HIV/STD epidemics even with major shifts in behavior.
•What about Africa? higher infectivity other structural patterns not modeled herenosocomial
•More broadly, factors other than numbers of unsafe partners can predispose or protect different populations from STD epidemics.
Acknowledgments
University of Washington CFAR
King HolmesMartina MorrisMark Handcock
The entire staff of CAPS’ Urban Men’s Health Study
Joseph CataniaRon StallTom Coates
The participants in the Urban Men’s Health Study