Projected Effects of Disruptions to Human Immunodeficiency Virus (HIV) Prevention Services During the Coronavirus Disease 2019 Pandemic Among Black/African American Men Who Have Sex With Men in an Ending the HIV Epidemic Priority Jurisdiction

Abstract

Disruptions in access to in-person HIV preventive care during the COVID-19 pandemic may have a negative impact on our progress towards the Ending the HIV Epidemic goals in the United States. We used an agent-based model to simulate HIV transmission among Black/African American men who have sex with men (MSM) in Mississippi over five years to estimate how different reductions in access affected the number of undiagnosed HIV cases, new PrEP starts, and HIV incidence. We found that each additional 25% decrease in HIV testing and PrEP initiation was associated with decrease of 20% in the number of cases diagnosed and 23% in the number of new PrEP starts, leading to a 15% increase in HIV incidence from 2020 to 2022. Unmet need for HIV testing and PrEP prescriptions during the COVID-19 pandemic may temporarily increase HIV incidence in the years immediately following the disruption period.

The relationship between age and sex partner counts during the mpox outbreak in the UK, 2022

“…Often in MSM disease transmission modelling, age is treated as a key determinant of sex act frequency. The focus in STI models has been on adults below about age 45 years, so much so that individuals near age 65+ may be retired out of the presumed sexually active population in models of MSM behaviour [3,4,28,29]. Our data and analysis support more sophisticated modelling of partner activity for persons age 65+.…”

“…To handle the skew, we apply two plausible distributions: negative binomial (including zero-partner count individuals) and Weibull (non-zero data only). The negative binomial distribution has been used for previous predictions of MSM partner or sex-act counts [4,11,14,16]. Removing zero-partner count responses (in last 3 weeks) from the dataset may be justified to explicitly separate individuals who are not sexually active.…”

“…Hence, reliable description of the distribution of unique partner counts during infectious periods is a key parameter for establishing credibility in disease transmission models dependent on intimate contact. Moreover, models that try to evaluate the merits of different infection control strategies in real-world populations may need to rely on plausible assumptions about distributions of partner counts that are known to relate to commonly measured demographic traits, especially age [3,4]. That published data about the relationship between age and partnership counts could be unrepresentative because of sampling methods was suggested previously: for instance, because of broad under-sampling of MSM [5] or because of dependence on Internet Apps that undersampled older MSM [6].…”

“…Often in such models, there is no variation in expected partner counts after age 16 or 17. Alternatively, partner count may be expected to decline at a similar rate with increased age for all partnership types [10], or individuals beyond a prespecified age are abruptly retired or removed from the population of interest/considered to be at risk, for instance at age 39-40 years [11,12], 65 years [4,13], or 65-67 years [14]. As at 16 September 2022, the median age of confirmed and highly probable cases from the 2022 UK mpox epidemic [15] was 36 years (IQR 30 to 44).…”

Modelling HIV/AIDS epidemiological complexity: A scoping review of Agent-Based Models and their application

“…However, this is different than explore how these social features impact the HIV/AIDS epidemic. Also, even with more than 30 studies published after 2021, just four of them explored the implications of Covid-19 on the HIV epidemics [55, [62][63][64]]-e.g., the effects on test, treatment, and social conditions. The implications of climate change, and growing poverty were also missed in the debate.…”