Network-related mechanisms may help explain long-term HIV-1 seroprevalence levels that remain high but do not approach population-group saturation

Samuel R. Friedman, Benny J. Kottiri, Alan Neaigus, Richard Curtis, Sten H. Vermund, Don Des Jarlais

Research output: Contribution to journalArticle

Abstract

In many cities, human immunodeficiency virus (HIV)-1 seroprevalence among drug injectors stabilizes at 30-70% for many years without secondary outbreaks that increase seroprevalence by 15% or more. The authors considered how HIV-1 incidence can remain moderate at seroprevalence levels that would give maximum incidence. Previously suggested answers include behavioral risk reduction and network saturation within high-risk subgroups. Among 767 drug injectors studied in 1991-1993, during a period of stable high seroprevalence in New York City, risk behaviors remained common, and networks were far from saturated. The authors suggest a different network-based mechanism: in stable high-prevalence situations, the relatively small sizes of subnetworks of linked seronegatives (within larger networks containing both infected and uninfected persons) may limit infectious outbreaks. Any primary infection outbreak would probably be limited to members of connected subcomponents of seronegatives, and the largest such subcomponent in the study contained only 18 members (of 415 seronegatives). Research and mathematical modeling should study conditions that may affect the size and stability of subcomponents of seronegatives. Finally, if the existence of small, connected components of seronegatives prevents secondary outbreaks, this protection may weaken, and vulnerability to new outbreaks increase, if HIV-1 seroprevalence falls. Thus, in situations of declining prevalence, prevention programs should be maintained or strengthened.

Original languageEnglish (US)
Pages (from-to)913-922
Number of pages10
JournalAmerican Journal of Epidemiology
Volume152
Issue number10
DOIs
StatePublished - Nov 15 2000

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Seroepidemiologic Studies
Population Groups
Disease Outbreaks
HIV-1
Incidence
Risk Reduction Behavior
Risk-Taking
Pharmaceutical Preparations
Infection
Research

Keywords

  • Disease outbreaks
  • Group processes
  • Group structure
  • HIV seroprevalence
  • HIV-1
  • Narcotics
  • Social environment
  • Social support

ASJC Scopus subject areas

  • Epidemiology

Cite this

Network-related mechanisms may help explain long-term HIV-1 seroprevalence levels that remain high but do not approach population-group saturation. / Friedman, Samuel R.; Kottiri, Benny J.; Neaigus, Alan; Curtis, Richard; Vermund, Sten H.; Des Jarlais, Don.

In: American Journal of Epidemiology, Vol. 152, No. 10, 15.11.2000, p. 913-922.

Research output: Contribution to journalArticle

Friedman, Samuel R. ; Kottiri, Benny J. ; Neaigus, Alan ; Curtis, Richard ; Vermund, Sten H. ; Des Jarlais, Don. / Network-related mechanisms may help explain long-term HIV-1 seroprevalence levels that remain high but do not approach population-group saturation. In: American Journal of Epidemiology. 2000 ; Vol. 152, No. 10. pp. 913-922.
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