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American Journal of Epidemiology Vol. 140, No. 3: 217-232
Copyright © 1994 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Effect of Sexual Behavior Change on Long-term Human Immunodeficiency Virus Prevalence among Homosexual Men

M. Morris1, and L Dean2

1Department of Sociology and School of Public Health, Columbia University New York, NY 10025
2School of Public Health, Columbia University New York, NY 10032

Reprint requests to Martina Morris, Department of Sociology, Columbia University, New York, NY 10027

Substantial changes in human immunodeficiency virus (HlV)-related sexual behavior have been reported by virtually every survey of homosexual/bisexual men in the last decade. This paper uses a behavior-based simulation to examine how such changes are likely to affect the long-term future of the acquired immunodeficiency syndrome (AIDS) epidemic among homosexual men. Data from the Longitudinal AIDS Impact Project in New York City are used to estimate age-specific patterns of unprotected anogenital contact and behavioral change from 1980 to 1991. Model projections are validated using New York City surveillance data on AIDS incidence from 1981 to 1991 The current levels of unsafe sex reported in the Longitudinal AIDS Impact Project are shown to be almost exactly on the epidemic threshold. If this behavior were maintained, HIV prevalence would slowty decline in the population, but with just one additional unsafe sexual partner per year HIV would instead become endemic, with seroprevalence of about 65% in the oldest group and about 25% in the youngest. Transmission dynamics in the youngest group are analyzed in detail. For this group, the assortative age-matching bias in partner selection patterns raises the unsafe behavior threshold slightly in the long run. Am J Epidemiol 1994;140:217–32.

acquired immunodeficiency syndrome; HIV infections; transmission; homosexuality; population dynamics; sex behavior


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