Attempting to explain heterogeneous HIV epidemics in sub-Saharan Africa: potential role of historical changes in risk behaviour and male circumcision
Identifieur interne : 003999 ( Istex/Corpus ); précédent : 003998; suivant : 003A00Attempting to explain heterogeneous HIV epidemics in sub-Saharan Africa: potential role of historical changes in risk behaviour and male circumcision
Auteurs : Kate K. Orroth ; Richard G. White ; Esther E. Freeman ; Roel Bakker ; Anne Buvé ; Judith R. Glynn ; J Dik F. Habbema ; Richard J. HayesSource :
- Sexually Transmitted Infections [ 1368-4973 ] ; 2011-12.
English descriptors
- KwdEn :
- Alternative scenarios, Behaviour, Biological cofactor effects, Biological cofactors, Casual partners, Circumcised, Circumcision, Circumcision interventions, Cities study, Cofactor, Cofactor effects, Cotonou, Default, Default scenario, Default scenarios, East africa, East african cities, Explosive spread, High levels, Kisumu, Male circumcision, Natural history, Ndola, Past year, Prevalence, Proportion circumcised, Risk behaviour, Risk behaviours, Scenario, Sexual behaviour, Sexual risk behaviour, Simulation, Stdsim, Study data, Systematic review, Transm, Transmission probability, Tropical medicine, West africa, West african cities, Yaound.
- Teeft :
- Alternative scenarios, Behaviour, Biological cofactor effects, Biological cofactors, Casual partners, Circumcised, Circumcision, Circumcision interventions, Cities study, Cofactor, Cofactor effects, Cotonou, Default, Default scenario, Default scenarios, East africa, East african cities, Explosive spread, High levels, Kisumu, Male circumcision, Natural history, Ndola, Past year, Prevalence, Proportion circumcised, Risk behaviour, Risk behaviours, Scenario, Sexual behaviour, Sexual risk behaviour, Simulation, Stdsim, Study data, Systematic review, Transm, Transmission probability, Tropical medicine, West africa, West african cities, Yaound.
Abstract
Background A key conclusion of the Four Cities Study, carried out to explore reasons for heterogeneity in the HIV epidemic between two cities in sub-Saharan Africa with relatively low prevalence (Cotonou and Yaoundé) and two with high prevalence (Kisumu and Ndola), was that differences in biological cofactors outweighed differences in sexual risk behaviours. The authors explore an alternative hypothesis, that risk behaviours were historically higher in the high-prevalence cities. They also investigate the effects of different prevalence of male circumcision on the HIV epidemics in the four cities. Methods A transmission model was fitted to data from the Four Cities Study. Default scenarios included biological cofactor effects on HIV transmission. Counter-factual scenarios were simulated without biological cofactors, with and without higher historical sexual behaviours, and with various rates of male circumcision. Results Simulated adult HIV prevalence in 1997 for the default scenarios was 3.1%, 7.8%, 28.9% and 27.1% in Cotonou, Yaoundé, Kisumu and Ndola, respectively, in line with data. Without biological cofactors, even implausibly high historical levels of risk behaviour in East Africa could not reproduce the observed heterogeneity in the late 1990s. Increasing the proportion of men circumcised in Ndola from 10% to 100% reduced HIV prevalence in 1997 to 7%. Decreasing the proportion circumcised in Yaoundé from 100% to 10% increased HIV prevalence to 26%. Conclusions Differences in male circumcision rates are likely to have played a key role in the heterogeneous spread of HIV across Africa. The effect of circumcision interventions can vary depending on the epidemic setting, with a larger effect in more generalised epidemics.
Url:
DOI: 10.1136/sextrans-2011-050174
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ISTEX:B14D12F02BD5FDF066A881E188311F91302B67C1Le document en format XML
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Orroth</name><affiliation><mods:affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: kate.orroth@gmail.com</mods:affiliation></affiliation></author><author><name sortKey="White, Richard G" sort="White, Richard G" uniqKey="White R" first="Richard G" last="White">Richard G. White</name><affiliation><mods:affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Freeman, Esther E" sort="Freeman, Esther E" uniqKey="Freeman E" first="Esther E" last="Freeman">Esther E. Freeman</name><affiliation><mods:affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Bakker, Roel" sort="Bakker, Roel" uniqKey="Bakker R" first="Roel" last="Bakker">Roel Bakker</name><affiliation><mods:affiliation>Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Buve, Anne" sort="Buve, Anne" uniqKey="Buve A" first="Anne" last="Buvé">Anne Buvé</name><affiliation><mods:affiliation>Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Glynn, Judith R" sort="Glynn, Judith R" uniqKey="Glynn J" first="Judith R" last="Glynn">Judith R. Glynn</name><affiliation><mods:affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Habbema, J Dik F" sort="Habbema, J Dik F" uniqKey="Habbema J" first="J Dik F" last="Habbema">J Dik F. Habbema</name><affiliation><mods:affiliation>Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Hayes, Richard J" sort="Hayes, Richard J" uniqKey="Hayes R" first="Richard J" last="Hayes">Richard J. Hayes</name><affiliation><mods:affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Sexually Transmitted Infections</title><title level="j" type="abbrev">Sex Transm Infect</title><idno type="ISSN">1368-4973</idno><idno type="eISSN">1472-3263</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2011-12">2011-12</date><biblScope unit="volume">87</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="640">640</biblScope></imprint><idno type="ISSN">1368-4973</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1368-4973</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Alternative scenarios</term><term>Behaviour</term><term>Biological cofactor effects</term><term>Biological cofactors</term><term>Casual partners</term><term>Circumcised</term><term>Circumcision</term><term>Circumcision interventions</term><term>Cities study</term><term>Cofactor</term><term>Cofactor effects</term><term>Cotonou</term><term>Default</term><term>Default scenario</term><term>Default scenarios</term><term>East africa</term><term>East african cities</term><term>Explosive spread</term><term>High levels</term><term>Kisumu</term><term>Male circumcision</term><term>Natural history</term><term>Ndola</term><term>Past year</term><term>Prevalence</term><term>Proportion circumcised</term><term>Risk behaviour</term><term>Risk behaviours</term><term>Scenario</term><term>Sexual behaviour</term><term>Sexual risk behaviour</term><term>Simulation</term><term>Stdsim</term><term>Study data</term><term>Systematic review</term><term>Transm</term><term>Transmission probability</term><term>Tropical medicine</term><term>West africa</term><term>West african cities</term><term>Yaound</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Alternative scenarios</term><term>Behaviour</term><term>Biological cofactor effects</term><term>Biological cofactors</term><term>Casual partners</term><term>Circumcised</term><term>Circumcision</term><term>Circumcision interventions</term><term>Cities study</term><term>Cofactor</term><term>Cofactor effects</term><term>Cotonou</term><term>Default</term><term>Default scenario</term><term>Default scenarios</term><term>East africa</term><term>East african cities</term><term>Explosive spread</term><term>High levels</term><term>Kisumu</term><term>Male circumcision</term><term>Natural history</term><term>Ndola</term><term>Past year</term><term>Prevalence</term><term>Proportion circumcised</term><term>Risk behaviour</term><term>Risk behaviours</term><term>Scenario</term><term>Sexual behaviour</term><term>Sexual risk behaviour</term><term>Simulation</term><term>Stdsim</term><term>Study data</term><term>Systematic review</term><term>Transm</term><term>Transmission probability</term><term>Tropical medicine</term><term>West africa</term><term>West african cities</term><term>Yaound</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background A key conclusion of the Four Cities Study, carried out to explore reasons for heterogeneity in the HIV epidemic between two cities in sub-Saharan Africa with relatively low prevalence (Cotonou and Yaoundé) and two with high prevalence (Kisumu and Ndola), was that differences in biological cofactors outweighed differences in sexual risk behaviours. The authors explore an alternative hypothesis, that risk behaviours were historically higher in the high-prevalence cities. They also investigate the effects of different prevalence of male circumcision on the HIV epidemics in the four cities. Methods A transmission model was fitted to data from the Four Cities Study. Default scenarios included biological cofactor effects on HIV transmission. Counter-factual scenarios were simulated without biological cofactors, with and without higher historical sexual behaviours, and with various rates of male circumcision. Results Simulated adult HIV prevalence in 1997 for the default scenarios was 3.1%, 7.8%, 28.9% and 27.1% in Cotonou, Yaoundé, Kisumu and Ndola, respectively, in line with data. Without biological cofactors, even implausibly high historical levels of risk behaviour in East Africa could not reproduce the observed heterogeneity in the late 1990s. Increasing the proportion of men circumcised in Ndola from 10% to 100% reduced HIV prevalence in 1997 to 7%. Decreasing the proportion circumcised in Yaoundé from 100% to 10% increased HIV prevalence to 26%. Conclusions Differences in male circumcision rates are likely to have played a key role in the heterogeneous spread of HIV across Africa. The effect of circumcision interventions can vary depending on the epidemic setting, with a larger effect in more generalised epidemics.</div></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>cofactor</json:string><json:string>male circumcision</json:string><json:string>kisumu</json:string><json:string>circumcision</json:string><json:string>circumcised</json:string><json:string>scenario</json:string><json:string>cotonou</json:string><json:string>yaound</json:string><json:string>risk behaviour</json:string><json:string>east africa</json:string><json:string>biological cofactors</json:string><json:string>cofactor effects</json:string><json:string>ndola</json:string><json:string>transm</json:string><json:string>default scenario</json:string><json:string>stdsim</json:string><json:string>transmission probability</json:string><json:string>past year</json:string><json:string>sexual risk behaviour</json:string><json:string>behaviour</json:string><json:string>sexual 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Heath, London School of Hygiene and Tropical Medicine, London, UK</json:string><json:string>E-mail: kate.orroth@gmail.com</json:string></affiliations></json:item><json:item><name>Richard G White</name><affiliations><json:string>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</json:string></affiliations></json:item><json:item><name>Esther E Freeman</name><affiliations><json:string>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</json:string></affiliations></json:item><json:item><name>Roel Bakker</name><affiliations><json:string>Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands</json:string></affiliations></json:item><json:item><name>Anne Buvé</name><affiliations><json:string>Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium</json:string></affiliations></json:item><json:item><name>Judith R Glynn</name><affiliations><json:string>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</json:string></affiliations></json:item><json:item><name>J Dik F Habbema</name><affiliations><json:string>Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands</json:string></affiliations></json:item><json:item><name>Richard J Hayes</name><affiliations><json:string>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>HIV epidemics</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>sub-Saharan Africa</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>circumcision</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>STIs</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>mathematical model</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Africa</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>HIV</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>mathematical model</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>tuberculosis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>transmission dynamics</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>infectious dis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>epidemiology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>STD clinic</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>HSV-2</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>vaginal infections</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>std surveillance</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cervical cancer</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>AIDS</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cervix</value></json:item></subject><articleId><json:string>sextrans-2011-050174</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Background A key conclusion of the Four Cities Study, carried out to explore reasons for heterogeneity in the HIV epidemic between two cities in sub-Saharan Africa with relatively low prevalence (Cotonou and Yaoundé) and two with high prevalence (Kisumu and Ndola), was that differences in biological cofactors outweighed differences in sexual risk behaviours. The authors explore an alternative hypothesis, that risk behaviours were historically higher in the high-prevalence cities. They also investigate the effects of different prevalence of male circumcision on the HIV epidemics in the four cities. Methods A transmission model was fitted to data from the Four Cities Study. Default scenarios included biological cofactor effects on HIV transmission. Counter-factual scenarios were simulated without biological cofactors, with and without higher historical sexual behaviours, and with various rates of male circumcision. Results Simulated adult HIV prevalence in 1997 for the default scenarios was 3.1%, 7.8%, 28.9% and 27.1% in Cotonou, Yaoundé, Kisumu and Ndola, respectively, in line with data. Without biological cofactors, even implausibly high historical levels of risk behaviour in East Africa could not reproduce the observed heterogeneity in the late 1990s. Increasing the proportion of men circumcised in Ndola from 10% to 100% reduced HIV prevalence in 1997 to 7%. Decreasing the proportion circumcised in Yaoundé from 100% to 10% increased HIV prevalence to 26%. Conclusions Differences in male circumcision rates are likely to have played a key role in the heterogeneous spread of HIV across Africa. The effect of circumcision interventions can vary depending on the epidemic setting, with a larger effect in more generalised epidemics.</abstract><qualityIndicators><score>7.805</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>19</keywordCount><abstractCharCount>1755</abstractCharCount><pdfWordCount>4305</pdfWordCount><pdfCharCount>27032</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>259</abstractWordCount></qualityIndicators><title>Attempting to explain heterogeneous HIV epidemics in sub-Saharan Africa: potential role of historical changes in risk behaviour and male circumcision</title><pmid><json:string>21926115</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>Sexually Transmitted Infections</title><language><json:string>unknown</json:string></language><issn><json:string>1368-4973</json:string></issn><eissn><json:string>1472-3263</json:string></eissn><publisherId><json:string>sti</json:string></publisherId><volume>87</volume><issue>7</issue><pages><first>640</first></pages><genre><json:string>journal</json:string></genre></host><categories><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string><json:string>gynecologie. andrologie. obstetrique</json:string></inist></categories><publicationDate>2011</publicationDate><copyrightDate>2011</copyrightDate><doi><json:string>10.1136/sextrans-2011-050174</json:string></doi><id>B14D12F02BD5FDF066A881E188311F91302B67C1</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/B14D12F02BD5FDF066A881E188311F91302B67C1/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/B14D12F02BD5FDF066A881E188311F91302B67C1/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/B14D12F02BD5FDF066A881E188311F91302B67C1/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Attempting to explain heterogeneous HIV epidemics in sub-Saharan Africa: potential role of historical changes in risk behaviour and male circumcision</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">BMJ Publishing Group Ltd</publisher><availability><licence><p>© 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</p></availability><date>2011-09-16</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Attempting to explain heterogeneous HIV epidemics in sub-Saharan Africa: potential role of historical changes in risk behaviour and male circumcision</title><author xml:id="author-0000" corresp="yes"><persName><forename type="first">Kate K</forename><surname>Orroth</surname></persName><email>kate.orroth@gmail.com</email><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Richard G</forename><surname>White</surname></persName><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Esther E</forename><surname>Freeman</surname></persName><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Roel</forename><surname>Bakker</surname></persName><affiliation>Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Anne</forename><surname>Buvé</surname></persName><affiliation>Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Judith R</forename><surname>Glynn</surname></persName><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation></author><author xml:id="author-0006"><persName><forename type="first">J Dik F</forename><surname>Habbema</surname></persName><affiliation>Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands</affiliation></author><author xml:id="author-0007"><persName><forename type="first">Richard J</forename><surname>Hayes</surname></persName><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation></author><idno type="istex">B14D12F02BD5FDF066A881E188311F91302B67C1</idno><idno type="ark">ark:/67375/NVC-VHP4JH98-J</idno><idno type="DOI">10.1136/sextrans-2011-050174</idno><idno type="href">sextrans-87-640.pdf</idno><idno type="article-id">sextrans-2011-050174</idno><idno type="PMID">21926115</idno><idno type="local">sextrans;87/7/640</idno></analytic><monogr><title level="j">Sexually Transmitted Infections</title><title level="j" type="abbrev">Sex Transm Infect</title><idno type="pISSN">1368-4973</idno><idno type="eISSN">1472-3263</idno><idno type="publisher-id">sti</idno><idno type="PublisherID-hwp">sextrans</idno><idno type="PublisherID-nlm-ta">Sex Transm Infect</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2011-12"></date><biblScope unit="volume">87</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="640">640</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011-09-16</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background A key conclusion of the Four Cities Study, carried out to explore reasons for heterogeneity in the HIV epidemic between two cities in sub-Saharan Africa with relatively low prevalence (Cotonou and Yaoundé) and two with high prevalence (Kisumu and Ndola), was that differences in biological cofactors outweighed differences in sexual risk behaviours. The authors explore an alternative hypothesis, that risk behaviours were historically higher in the high-prevalence cities. They also investigate the effects of different prevalence of male circumcision on the HIV epidemics in the four cities. Methods A transmission model was fitted to data from the Four Cities Study. Default scenarios included biological cofactor effects on HIV transmission. Counter-factual scenarios were simulated without biological cofactors, with and without higher historical sexual behaviours, and with various rates of male circumcision. Results Simulated adult HIV prevalence in 1997 for the default scenarios was 3.1%, 7.8%, 28.9% and 27.1% in Cotonou, Yaoundé, Kisumu and Ndola, respectively, in line with data. Without biological cofactors, even implausibly high historical levels of risk behaviour in East Africa could not reproduce the observed heterogeneity in the late 1990s. Increasing the proportion of men circumcised in Ndola from 10% to 100% reduced HIV prevalence in 1997 to 7%. Decreasing the proportion circumcised in Yaoundé from 100% to 10% increased HIV prevalence to 26%. Conclusions Differences in male circumcision rates are likely to have played a key role in the heterogeneous spread of HIV across Africa. The effect of circumcision interventions can vary depending on the epidemic setting, with a larger effect in more generalised epidemics.</p></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>HIV epidemics</term></item><item><term>sub-Saharan Africa</term></item><item><term>circumcision</term></item><item><term>STIs</term></item><item><term>mathematical model</term></item><item><term>Africa</term></item><item><term>HIV</term></item><item><term>mathematical model</term></item><item><term>tuberculosis</term></item><item><term>transmission dynamics</term></item><item><term>infectious dis</term></item><item><term>epidemiology</term></item><item><term>STD clinic</term></item><item><term>HSV-2</term></item><item><term>vaginal infections</term></item><item><term>std surveillance</term></item><item><term>cervical cancer</term></item><item><term>AIDS</term></item><item><term>cervix</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2011-09-16">Created</change><change when="2011-12">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/B14D12F02BD5FDF066A881E188311F91302B67C1/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">sextrans</journal-id><journal-id journal-id-type="nlm-ta">Sex Transm Infect</journal-id><journal-id journal-id-type="publisher-id">sti</journal-id><journal-title>Sexually Transmitted Infections</journal-title><abbrev-journal-title abbrev-type="publisher">Sex Transm Infect</abbrev-journal-title><abbrev-journal-title>Sex Transm Infect</abbrev-journal-title><issn pub-type="ppub">1368-4973</issn><issn pub-type="epub">1472-3263</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">sextrans-2011-050174</article-id><article-id pub-id-type="doi">10.1136/sextrans-2011-050174</article-id><article-id pub-id-type="other">sextrans;87/7/640</article-id><article-id pub-id-type="other">sextrans;sextrans-2011-050174</article-id><article-id pub-id-type="pmid">21926115</article-id><article-id pub-id-type="other">640</article-id><article-id pub-id-type="other">sextrans-2011-050174</article-id><article-categories><subj-group subj-group-type="heading"><subject>AIDS 2031</subject></subj-group><series-title>Original article</series-title></article-categories><title-group><article-title>Attempting to explain heterogeneous HIV epidemics in sub-Saharan Africa: potential role of historical changes in risk behaviour and male circumcision</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Orroth</surname><given-names>Kate K</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>White</surname><given-names>Richard G</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Freeman</surname><given-names>Esther E</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Bakker</surname><given-names>Roel</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Buvé</surname><given-names>Anne</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Glynn</surname><given-names>Judith R</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Habbema</surname><given-names>J Dik F</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Hayes</surname><given-names>Richard J</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</aff><aff id="aff2"><label>2</label>Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands</aff><aff id="aff3"><label>3</label>Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium</aff><author-notes><corresp><label>Correspondence to</label> Dr Kate K Orroth, Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; <email>kate.orroth@gmail.com</email></corresp></author-notes><pub-date pub-type="epub-original"><day>16</day><month>9</month><year>2011</year></pub-date><pub-date pub-type="ppub"><month>12</month><year>2011</year></pub-date><pub-date pub-type="epub"><day>16</day><month>9</month><year>2011</year></pub-date><volume>87</volume><volume-id pub-id-type="other">87</volume-id><volume-id pub-id-type="other">87</volume-id><issue>7</issue><issue-id pub-id-type="other">sextrans;87/7</issue-id><issue-id pub-id-type="other">7</issue-id><issue-id pub-id-type="other">87/7</issue-id><fpage>640</fpage><history><date date-type="accepted"><day>14</day><month>7</month><year>2011</year></date></history><permissions><copyright-statement>© 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</copyright-statement><copyright-year>2011</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="sextrans-87-640.pdf"></self-uri><abstract><sec><title>Background</title><p>A key conclusion of the Four Cities Study, carried out to explore reasons for heterogeneity in the HIV epidemic between two cities in sub-Saharan Africa with relatively low prevalence (Cotonou and Yaoundé) and two with high prevalence (Kisumu and Ndola), was that differences in biological cofactors outweighed differences in sexual risk behaviours. The authors explore an alternative hypothesis, that risk behaviours were historically higher in the high-prevalence cities. They also investigate the effects of different prevalence of male circumcision on the HIV epidemics in the four cities.</p></sec><sec><title>Methods</title><p>A transmission model was fitted to data from the Four Cities Study. Default scenarios included biological cofactor effects on HIV transmission. Counter-factual scenarios were simulated without biological cofactors, with and without higher historical sexual behaviours, and with various rates of male circumcision.</p></sec><sec><title>Results</title><p>Simulated adult HIV prevalence in 1997 for the default scenarios was 3.1%, 7.8%, 28.9% and 27.1% in Cotonou, Yaoundé, Kisumu and Ndola, respectively, in line with data. Without biological cofactors, even implausibly high historical levels of risk behaviour in East Africa could not reproduce the observed heterogeneity in the late 1990s. Increasing the proportion of men circumcised in Ndola from 10% to 100% reduced HIV prevalence in 1997 to 7%. Decreasing the proportion circumcised in Yaoundé from 100% to 10% increased HIV prevalence to 26%.</p></sec><sec><title>Conclusions</title><p>Differences in male circumcision rates are likely to have played a key role in the heterogeneous spread of HIV across Africa. The effect of circumcision interventions can vary depending on the epidemic setting, with a larger effect in more generalised epidemics.</p></sec></abstract><kwd-group><kwd>HIV epidemics</kwd><kwd>sub-Saharan Africa</kwd><kwd>circumcision</kwd><kwd>STIs</kwd><kwd>mathematical model</kwd><kwd>Africa</kwd><kwd>HIV</kwd><kwd>mathematical model</kwd><kwd>tuberculosis</kwd><kwd>transmission dynamics</kwd><kwd>infectious dis</kwd><kwd>epidemiology</kwd><kwd>STD clinic</kwd><kwd>HSV-2</kwd><kwd>vaginal infections</kwd><kwd>std surveillance</kwd><kwd>cervical cancer</kwd><kwd>AIDS</kwd><kwd>cervix</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Attempting to explain heterogeneous HIV epidemics in sub-Saharan Africa: potential role of historical changes in risk behaviour and male circumcision</title><partName>Original article</partName></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Attempting to explain heterogeneous HIV epidemics in sub-Saharan Africa: potential role of historical changes in risk behaviour and male circumcision</title><partName>Original article</partName></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Kate K</namePart><namePart type="family">Orroth</namePart><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation><affiliation>E-mail: kate.orroth@gmail.com</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Richard G</namePart><namePart type="family">White</namePart><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Esther E</namePart><namePart type="family">Freeman</namePart><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Roel</namePart><namePart type="family">Bakker</namePart><affiliation>Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anne</namePart><namePart type="family">Buvé</namePart><affiliation>Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Judith R</namePart><namePart type="family">Glynn</namePart><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J Dik F</namePart><namePart type="family">Habbema</namePart><affiliation>Department of Public Health, Erasmus University Rotterdam, Rotterdam, the Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Richard J</namePart><namePart type="family">Hayes</namePart><affiliation>Epidemiology and Public Heath, London School of Hygiene and Tropical Medicine, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2011-12</dateIssued><dateCreated encoding="w3cdtf">2011-09-16</dateCreated><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract>Background A key conclusion of the Four Cities Study, carried out to explore reasons for heterogeneity in the HIV epidemic between two cities in sub-Saharan Africa with relatively low prevalence (Cotonou and Yaoundé) and two with high prevalence (Kisumu and Ndola), was that differences in biological cofactors outweighed differences in sexual risk behaviours. The authors explore an alternative hypothesis, that risk behaviours were historically higher in the high-prevalence cities. They also investigate the effects of different prevalence of male circumcision on the HIV epidemics in the four cities. Methods A transmission model was fitted to data from the Four Cities Study. Default scenarios included biological cofactor effects on HIV transmission. Counter-factual scenarios were simulated without biological cofactors, with and without higher historical sexual behaviours, and with various rates of male circumcision. Results Simulated adult HIV prevalence in 1997 for the default scenarios was 3.1%, 7.8%, 28.9% and 27.1% in Cotonou, Yaoundé, Kisumu and Ndola, respectively, in line with data. Without biological cofactors, even implausibly high historical levels of risk behaviour in East Africa could not reproduce the observed heterogeneity in the late 1990s. Increasing the proportion of men circumcised in Ndola from 10% to 100% reduced HIV prevalence in 1997 to 7%. Decreasing the proportion circumcised in Yaoundé from 100% to 10% increased HIV prevalence to 26%. Conclusions Differences in male circumcision rates are likely to have played a key role in the heterogeneous spread of HIV across Africa. The effect of circumcision interventions can vary depending on the epidemic setting, with a larger effect in more generalised epidemics.</abstract><subject><genre>keywords</genre><topic>HIV epidemics</topic><topic>sub-Saharan Africa</topic><topic>circumcision</topic><topic>STIs</topic><topic>mathematical model</topic><topic>Africa</topic><topic>HIV</topic><topic>mathematical model</topic><topic>tuberculosis</topic><topic>transmission dynamics</topic><topic>infectious dis</topic><topic>epidemiology</topic><topic>STD clinic</topic><topic>HSV-2</topic><topic>vaginal infections</topic><topic>std surveillance</topic><topic>cervical cancer</topic><topic>AIDS</topic><topic>cervix</topic></subject><relatedItem type="host"><titleInfo><title>Sexually Transmitted Infections</title></titleInfo><titleInfo type="abbreviated"><title>Sex Transm Infect</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">1368-4973</identifier><identifier type="eISSN">1472-3263</identifier><identifier type="PublisherID">sti</identifier><identifier type="PublisherID-hwp">sextrans</identifier><identifier type="PublisherID-nlm-ta">Sex Transm Infect</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>87</number></detail><detail type="issue"><caption>no.</caption><number>7</number></detail><extent unit="pages"><start>640</start></extent></part></relatedItem><identifier type="istex">B14D12F02BD5FDF066A881E188311F91302B67C1</identifier><identifier type="ark">ark:/67375/NVC-VHP4JH98-J</identifier><identifier type="DOI">10.1136/sextrans-2011-050174</identifier><identifier type="href">sextrans-87-640.pdf</identifier><identifier type="ArticleID">sextrans-2011-050174</identifier><identifier type="PMID">21926115</identifier><identifier type="local">sextrans;87/7/640</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2011, Published by the BMJ Publishing Group Limited. 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