Estimating sizes of hidden or hard-to-reach populations is an important problem in public health. For example, estimates of the sizes of populations at highest risk for HIV and AIDS are needed for designing, evaluating and allocating funding for treatment and prevention programmes. A promising approach to size estimation, relatively new to public health, is the network scale-up method (NSUM), involving two steps: estimating the personal network size of the members of a random sample of a total population and, with this information, estimating the number of members of a hidden subpopulation of the total population. We describe the method, including two approaches to estimating personal network sizes (summation and known population). We discuss the strengths and weaknesses of each approach and provide examples of international applications of the NSUM in public health. We conclude with recommendations for future research and evaluation.
This article presents a conceptual framework for the study of the distribution and determinants of human immunodeficiency virus (HIV) infection in populations, by combining demographic and epidemiological approaches. The proximate-determinants framework has been applied extensively in the study of fertility and child survival in developing countries. Key to the framework is the identification of a set of variables, called "proximate determinants," that can be influenced by changes in contextual variables or by interventions and that have a direct effect on biological mechanisms to influence health outcomes. In HIV research, the biological mechanisms are the components that determine the reproductive rate of infection. The proximate-determinants framework can be used in study design, in the analysis and interpretation of risk factors or intervention studies that include both biological and behavioral data, and in ecological studies.
The use of a nonoxynol 9 vaginal film did not reduce the rate of new HIV, gonorrhea, or chlamydia infection in this group of sex workers who used condoms and received treatment for sexually transmitted diseases.
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