The Hidden Epidemic Confronting Sexually Transmitted Diseases (1997) / Chapter Skim
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APPENDIX C
APPENDIX C
Pages 316-329
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From page 316... ...
Chlamydial infection is specifically modeled because it affects a large proportion of individuals not usually at risk for STDs and could therefore play an important role in heterosexually transmitted HIV infections, not only from high-risk to low-risk groups but also within lowrisk groups. Results of the model will be discussed in relation to all curable STDs.
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From page 317... ...
The most important assumptions when evaluating the potential impact of STDs on heterosexual HIV transmission center around HIV transmission probabilities in the absence of STDs, the sexual network and the distribution of sexual activity in the general population, the prevalence of STDs, and the nature and the magnitude of the interrelationships between STDs and HIV infection. These parameters determine whether HIV, in the presence or absence of STDs, can establish in the population and what the rate of spread of HIV in different risk groups will be.
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From page 318... ...
The predicted HIV and AIDS trends and estimates of the fraction of cases attributable to cofactor chlamydia were produced using different sets of realistic parameter assumptions in which HIV transmission probabilities were varied depending on the magnitude of association used. The various biological and demographic parameter values used for chlamydial and HIV infection are summarized in Table C-3, and those on sexual behavior and initial chlamydia prevalence are
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From page 320... ...
TABLE C-3 Epidemiological and Demographic Parameters Used in the Simulations Parameters SymbolsValues Sexually active population size in 1995 P°Pfemale= 1~01 P°Pmale 171,481,800 Population growth rate in absence of HIV ~1.1% Age at sexual maturation ~15 yrs Average duration of sexual activity (taking Dsa 55 yrs account of background mortality) in the absence of HIV-1 infection Perinatal transmission {probability} £ 30% Life expectancy of AIDS patient DAIDs 1 yr Average time from infection to the development of AIDS (incubation period)
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From page 321... ...
. RESULTS The predicted prevalence and incidence trends of HIV infection from 1980 to the year 2005 in the sexually active heterosexual population are depicted in (a)
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From page 322... ...
The rate at which HIV will propagate and the maximum fraction of the population afflicted by HIV infection are highly dependent on the degree to which chlamydial infection enhances HIV transmission and on the prevalence of chlamydial infection. At the time of introduction of HIV in the population in 1980, chlamydial infection affected 0.72 percent and 0.68 percent of the general female and male population (weighted average of the different activity classes)
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From page 323... ...
heterosexual population. Graph A represents the general population (both sexes and all sexual activity classes)
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From page 325... ...
show that a more assortative mixing or a majority of individuals having a low rate of partner change accentuate partner formation between high-activity classes. Thus, even with a lower level of sexual activity, a more assortative mixing would favor STD establishment and transmission.
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From page 326... ...
heterosexual population, one optimistic point emerges from this study. This is the important fraction of heterosexually transmitted HIV infections that can be prevented by treating chlamydial infection and other curable STDs.
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From page 327... ...
Human immunodeficiency virus transmission and the role of other sexually transmitted diseases: measures of association and study design. Sex Transm Dis 1996;23:312-30.
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From page 328... ...
Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomized controlled trial [see comments]
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From page 329... ...
Influence of HIV infection on manifestations and natural history of other sexually transmitted diseases. Ann Rev Public Health 1993;14:19-42.
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