American Journal of Epidemiology Vol. 152, No. 10 : 913-922
Copyright © 2000 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Network-related Mechanisms May Help Explain Long-term HIV-1 Seroprevalence Levels That Remain High but Do Not Approach Population-Group Saturation
1 Institute for AIDS Research, National Development and Research Institutes, Inc., New York, NY.
2 Department of Anthropology, John Jay College of Criminal Justice, New York, NY.
3 Department of Epidemiology and International Health, University of Alabama, Birmingham, AL.
4 Chemical Dependency Institute, Beth Israel Medical Center, New York, NY.
In many cities, human immunodeficiency virus (HIV)-1 seroprevalence among drug injectors stabilizes at 30–70% for many years without secondary outbreaks that increase seroprevalence by 15% or more. The authors considered how HIV-1 incidence can remain moderate at seroprevalence levels that would give maximum incidence. Previously suggested answers include behavioral risk reduction and network saturation within high-risk subgroups. Among 767 drug injectors studied in 1991–1993, during a period of stable high seroprevalence in New York City, risk behaviors remained common, and networks were far from saturated. The authors suggest a different network-based mechanism: in stable high-prevalence situations, the relatively small sizes of subnetworks of linked seronegatives (within larger networks containing both infected and uninfected persons) may limit infectious outbreaks. Any primary infection outbreak would probably be limited to members of connected subcomponents of seronegatives, and the largest such subcomponent in the study contained only 18 members (of 415 seronegatives). Research and mathematical modeling should study conditions that may affect the size and stability of subcomponents of seronegatives. Finally, if the existence of small, connected components of seronegatives prevents secondary outbreaks, this protection may weaken, and vulnerability to new outbreaks increase, if HIV-1 seroprevalence falls. Thus, in situations of declining prevalence, prevention programs should be maintained or strengthened. Am J Epidemiol 2000;152:913–22.
disease outbreaks; group processes; group structure; HIV-1; HIV seroprevalence; narcotics; social environment; social support
Abbreviations: HIV, human immunodeficiency virus; IDU, injecting drug user
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