PMID- 20852405
OWN - NLM
STAT- MEDLINE
DCOM- 20110325
LR  - 20181201
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 24
IP  - 16
DP  - 2010 Oct 23
TI  - To what extent is the HIV epidemic in southern India driven by commercial sex? A 
      modelling analysis.
PG  - 2563-72
LID - 10.1097/QAD.0b013e32833e8663 [doi]
AB  - BACKGROUND: In south India, general population HIV prevalence estimates range 
      from 0.5 to 3%. To focus HIV prevention efforts, it is important to understand 
      whether HIV transmission is driven by commercial sex. METHODS: A dynamic 
      HIV/sexually transmitted infection transmission model was parameterized using 
      data from Belgaum and Mysore in south India. Fits to sexually transmitted 
      infection/HIV data from female sex workers (FSWs) and their clients for each 
      district were obtained. Model HIV/herpes simplex virus-2 (HSV-2) prevalence 
      projections for the general population were cross-validated against empirical 
      estimates not used to fit model. The model estimated the proportion of incident 
      HIV/HSV-2 infections due to HIV/HSV-2 transmission between FSWs/clients, their 
      noncommercial partners and other low-risk partnerships. The relative impact of a 
      generic intervention targeting different partnerships was explored. RESULTS: The 
      model's general population HIV/HSV-2 prevalence projections agreed well with 
      empirical estimates. Recent increases in condom use resulted in decreasing HIV 
      epidemics in both settings. For men, most incident HIV/HSV-2 infections (>90%) 
      directly result from commercial sex, whereas for women most are due to bridging 
      infections from clients of FSWs (80-90%) with the remainder mainly due to 
      commercial sex. Less than 1.5% of incident infections are due to low-risk 
      partnerships. Intervention impact is maximized through targeting commercial sex 
      but substantial impact could also be achieved through targeting noncommercial 
      partners of clients. DISCUSSION: In southern India, HIV transmission could be 
      driven by FSWs and their clients. While efforts to reduce HIV transmission due to 
      commercial sex must continue, prevention programmes should also consider 
      strategies to prevent transmission from clients to their noncommercial partners.
FAU - Vickerman, Peter
AU  - Vickerman P
AD  - London School of Hygiene and Tropical Medicine, London, UK. 
      peter.vickerman@lshtm.ac.uk
FAU - Foss, Anna M
AU  - Foss AM
FAU - Pickles, Michael
AU  - Pickles M
FAU - Deering, Kathleen
AU  - Deering K
FAU - Verma, Supriya
AU  - Verma S
FAU - Eric Demers
AU  - Eric Demers
FAU - Lowndes, Catherine M
AU  - Lowndes CM
FAU - Moses, Stephen
AU  - Moses S
FAU - Alary, Michel
AU  - Alary M
FAU - Boily, Marie-Claude
AU  - Boily MC
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
SB  - IM
MH  - Adult
MH  - Condoms/*statistics & numerical data
MH  - Disease Outbreaks
MH  - Female
MH  - HIV Infections/epidemiology/prevention & control/*transmission
MH  - Health Promotion
MH  - Herpes Genitalis/epidemiology/prevention & control/*transmission
MH  - Herpesvirus 2, Human
MH  - Humans
MH  - India/epidemiology
MH  - Male
MH  - *Models, Statistical
MH  - Risk Factors
MH  - Sex Work/*statistics & numerical data
MH  - Sexually Transmitted Diseases/epidemiology/prevention & control/*transmission
EDAT- 2010/09/21 06:00
MHDA- 2011/03/26 06:00
CRDT- 2010/09/21 06:00
PHST- 2010/09/21 06:00 [entrez]
PHST- 2010/09/21 06:00 [pubmed]
PHST- 2011/03/26 06:00 [medline]
AID - 10.1097/QAD.0b013e32833e8663 [doi]
PST - ppublish
SO  - AIDS. 2010 Oct 23;24(16):2563-72. doi: 10.1097/QAD.0b013e32833e8663.