The impact of HIV epidemic phases on the effectiveness of core group interventions: insights from mathematical models

Mc, Boily; Lowndes, Catherine M; Alary, Michel

doi:10.1136/sti.78.suppl_1.i78

Cited by 102 publications

(88 citation statements)

References 42 publications

(24 reference statements)

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“…Por meio de modelagem matemática, mostra-se que para epidemias com uma baixa reprodução potencial, intervenções modestas em grupos de alto risco podem reduzir significativamente a incidência e prevalência de HIV. Já em países com epidemias generalizadas, intervenções efetivas devem incluir grupos de alto e baixo riscos já que as intervenções em grupos de alto risco são necessárias, mas não suficientes para obter rápido impacto e em larga escala 3 .…”

Section: Introductionunclassified

Tendências da epidemia de AIDS entre subgrupos sob maior risco no Brasil, 1980-2004

et al. 2009

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O presente trabalho tem por objetivo apresentar as tendências da epidemia de AIDS em grupos populacionais sob maior risco no Brasil. A técnica de análise discriminante foi utilizada para reclassificação dos casos masculinos com categoria de exposição ignorada em um dos três grupos homens que fazem sexo com homens (HSH), usuários de drogas injetáveis (UDI) ou heterossexuais. Foram estimadas as taxas de incidência de AIDS por sexo e categoria de exposição no período 1980-2004. No período 1980-1988, os casos homossexuais ou bissexuais masculinos correspondiam a 63,6% dos casos, e a proporção de mulheres era de 10%. Posteriormente, há um decréscimo importante no papel desempenhado pelos HSH e ocorre um acréscimo nas outras categorias de exposição. Apesar das tendências de decréscimo para as incidências de casos HSH e UDI e acréscimo entre os heterossexuais masculinos e as mulheres, quando as taxas de incidência são comparadas o risco é maior entre os HSH e UDI. A análise da dinâmica da epidemia de AIDS no Brasil mostra a importância dos grupos HSH e UDI masculinos enquanto grupos de risco diferenciado.

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Section: Introductionunclassified

Tendências da epidemia de AIDS entre subgrupos sob maior risco no Brasil, 1980-2004

et al. 2009

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“…Kreiss et al (1986), Plummer et al (1991), Moses et al (1991) and Boily et al (2002), for example, have all suggested that female sex workers constitute a core group worthy of targeted health promotion campaigns. Their research is based upon clinical and quantitative socio-epidemiological data.…”

Section: Introductionmentioning

confidence: 99%

“…Commercial sex workers are widely believed to play a central role in the transmission of HIV in parts of Africa (D'Costa et al, 1985;Moses et al, 1991;Steen et al, 2000;Boily et al, 2002); Asia (Hanenberg et al, 1994) and Europe (Aral et al, 2003); and they are often referred to as core groups by epidemiologists, mathematical modellers, clinicians and policymakers as a way of highlighting the disproportionately large role they can play in the transmission of HIV. Drawing upon epidemiological and clinical research, academics and policymakers have also suggested that interventions targeting commercial sex workers provide a cost-effective way of reducing the transmission of HIV and other sexually transmitted infections.…”

Section: Introductionmentioning

confidence: 99%

Core Groups and the Transmission of Hiv: Learning From Male Sex Workers

Parker

2005

J. Biosoc. Sci.

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Summary.A growing and substantial body of research suggests that female sex workers play a disproportionately large role in the transmission of HIV in many parts of the world, and they are often referred to as core groups by epidemiologists, mathematical modellers, clinicians and policymakers. Male sex workers, by contrast, have received little attention and it is not known whether it is helpful to conceptualize them as a core group. This paper draws upon ethnographic research documenting social and sexual networks in London and looks at the position of five male sex workers within a network comprising 193 men and seven women (as well as 1378 anonymous sexual contacts and 780 commercial contacts). In so doing, it suggests that there is no evidence to show that male sex workers are more or less likely to acquire or transmit HIV in the course of commercial sex compared with other types of sexual relationships. In addition, men engaging in non-commercial sex all reported having unprotected sex in a variety of contexts and relationships and there is no evidence to suggest that men who are not sex workers play less of a role in the transmission of HIV. In short, these data suggest that it would be inappropriate to conceptualize male sex workers as a core group. This is not to suggest that public policy should continue to overlook male sex workers. New and inventive approaches are required to reach out to a vulnerable but diverse group of men, selling sex for a variety of reasons; even if these men are no more vulnerable to acquiring and/or transmitting HIV than other men and women that form part of their network.

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“…Mathematical models suggest that targeting core-groups, such as sex workers (SWs), is an effective way to reduce HIV transmission, particularly in the early and accelerated phase of the epidemic (Aral & Blanchard 2002;Boily et al 2002). Given the scale of sex work, with incomes equivalent to 2-14% of Southeast Asia's gross domestic product (Lin 1998), there is an urgent need to identify which interventions are effective in reducing HIV in SWs.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

Shahmanesh

Patel

Mabey

et al. 2008

Tropical Med Int Health

211

154

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Summaryobjective To systematically review the evidence for effectiveness of HIV and sexually transmitted infection (STI) prevention interventions in female sex workers in resource poor settings.method Published and unpublished studies were identified through electronic databases (Cochrane database, Medline, Embase, and Web of Science), hand searching and contacting experts. Randomizedcontrolled-trials and quasi-experimental studies were included if they were conducted in female sex workers from low and middle income settings; if the exposure was described; if the outcome was externally measurable, it was after the discovery of HIV, and if follow-up was longer than 6 months. A priori criteria were used to extract data. Meta-analysis was not performed due to the heterogeneity of studies.results Twenty-eight interventions were included. Despite methodological limitations, the evidence suggested that combining sexual risk reduction, condom promotion and improved access to STI treatment reduces HIV and STI acquisition in sex workers receiving the intervention. Strong evidence that regular STI screening or periodic treatment of STIs confers additional protection against HIV was lacking. It appears that structural interventions, policy change or empowerment of sex workers, reduce the prevalence of STIs and HIV.conclusion Rigorous evaluation of HIV ⁄ STI prevention interventions in sex workers is challenging. There is some evidence for the efficacy of multi-component interventions, and ⁄ or structural interventions. The effect of these interventions on the wider population has rarely been evaluated.

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The impact of HIV epidemic phases on the effectiveness of core group interventions: insights from mathematical models

Cited by 102 publications

References 42 publications

Tendências da epidemia de AIDS entre subgrupos sob maior risco no Brasil, 1980-2004

Tendências da epidemia de AIDS entre subgrupos sob maior risco no Brasil, 1980-2004

Core Groups and the Transmission of Hiv: Learning From Male Sex Workers

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

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