The objective was to estimate the likely percentage of HIV infections that may be attributable to one-off partnerships (such as those between female sex workers and their clients) and longer-term partnerships in rural Uganda. This was addressed by the application of a microsimulation model (SimulAIDS) of the transmission dynamics of HIV infection, drawing on data from a population cohort of 10,000 in rural Uganda. For a scenario reproducing documented characteristics of the study population in 1990, when adult HIV prevalence was 9%, and during subsequent follow up (1990–1994), when adult HIV incidence was 8 per 1000 person-years, the percentage of HIV infections in men (women) attributed to one-off partnerships decreased from 96% (26%) during 1980 to 67% (8%) in 1989 and 22% (5%) in 1994. Reducing HIV transmission between one-off partners early in an HIV epidemic may substantially limit the potential for the spread of HIV infection. At a later phase, prevention must also focus on control of transmission between longer-term HIV-discordant partners.
BuvéA., CaraëlM., HayesH., RobinsonN.J.. Variations in HIV prevalence between urban areas in sub-Saharan Africa: do we understand them?AIDS1995; 9(suppl A): S103–9
2.
The Status and Trends of the Global HIV/AIDS Pandemic Symposium Final Report. Vancouver, 5-6 July 1996. AIDSCAP/Family Health International, Harvard School of Public Health and UNAIDS, 1996
3.
PlummerF.A., NagelkerkeN.J.D., MosesS., Ndinya-AcholaJ.O., BwayoJ., NgugiE.. The importance of core groups in the epidemiology and control of HIV-1 infection.AIDS1991; 5(suppl 1): S169–76
4.
RowleyJ.T., AndersonR.M., Wan NgT.. Reducing the spread of HIV infection in sub-Saharan Africa: some demographic and economic implications.AIDS1990; 4: 47–56
5.
RowleyJ.T., AndersonR.M.. Modeling the impact and cost-effectiveness of HIV prevention efforts.AIDS1994; 8: 539–48
6.
GarnettG.P., AndersonR.M.. Strategies for limiting the spread of HIV in developing countries: conclusions based on studies of the transmission dynamics of the virus.J AIDS1995; 9: 500–13
7.
GarnettG.P., AndersonR.M.. Sexually transmitted diseases and sexual behaviour: insights from mathematical models.J Infect Dis1996; 174(suppl 2): S150–61
8.
OverM., PiotP.. Human immunodeficiency virus infection and other sexually transmitted diseases in developing countries: public health importance and priorities for resource allocation.J Infect Dis1996; 174(suppl 2): S162–75
9.
ThomasJ.C., TuckerM.J.. The development and use of the concept of a sexually transmitted disease core.J Infect Dis1996; 174(suppl 2): S134–43
10.
StoverJ.. Reducing the costs of effective AIDS control programmes through appropriate targeting of interventions (Abstract Th.C.201). XI International AIDS Conference, Vancouver, July 1996
11.
WasserheitJ.N., AralS.O.. The dynamic topology of sexually transmitted disease epidemics: implications for prevention strategies.J Infect Dis1996; 174(suppl 2): S201–13
12.
MulderD., NunnA., KamaliA., Kengeya-KayondoJ.. Decreasing HIV-1 seroprevalence in young adults in a rural Ugandan cohort.BMJ1995; 311: 833–6
13.
NunnA.J., Kengeya-KayondoJ.F., MalambaS.S., SeeleyJ.A., MulderD.W.. Risk factors for HIV-1 infection in adults in a rural Ugandan community: a population study.AIDS1994; 8: 81–6
14.
Kengeya-KayondoJ.F., KamaliA., NunnA.J., RuberantwariA., WagnerH-U, MulderD.W.. Incidence of HIV-1 infection in adults and socio-demographic characteristics of seroconverters in a rural population in Uganda: 1990-1994.Int J Epidemiol1996; 25: 1077–82
15.
RobinsonN.J., MulderD.W., AuvertB., HayesR.J.. Modelling the impact of alternative HIV intervention strategies in rural Uganda.AIDS1995; 9: 1263–70
16.
RobinsonN.J., MulderD.W., AuvertB., HayesR.J.. Proportion of HIV infections attributable to other sexually transmitted diseases in a rural Ugandan population: simulation model estimates.Int J Epidemiol1997; 26: 180–9
17.
RobinsonN.J., HayesR., MulderD.. Using condoms to prevent transmission of HIV (letter).BMJ1993; 307: 1007
18.
AuvertB., MooreM., BertrandW.E.. Dynamics of HIV infection and AIDS in Central African cities.Int J Epidemiol1990; 19: 417–28
19.
MulderD.W., NunnA.J., KamaliA., NakiyingiJ., WagnerH.U., Kengeya-KayondoJ.F.. Two year HIV-1-associated mortality in a Ugandan rural population.Lancet1994; 343: 1021–3
20.
MalambaS.S., WagnerH.U., MaudeG.. Risk factors for HIV-1 infection in adults in a rural Ugandan community: a case-control study.AIDS1994; 8: 253–7
21.
WagnerH.U., Van DykeE., RoggenE.. Seroprevalence and incidence of sexually transmitted diseases in a rural Ugandan population.Int J STD AIDS1994; 5: 332–7
22.
CoaleA.J., DemenyP.. Regional Model Life Tables and Stable Populations, 2nd edn.London: Academic Press Inc, 1988
23.
FeachemR.G.A., KjellstromT., MurrayC.J.L., OverM., PhillipsM.A. eds. The Health of Adults in the Developing World.New York: Oxford University Press for the World Bank, 1992
24.
HillA.. Infant and child mortality: levels, trends and data deficiencies. In: FeachemR.G., JamisonD.T., eds. Disease and Mortality in Sub-Saharan Africa.New York: Oxford University Press for the World Bank, 1991: 37–74.
25.
NunnA.J., MulderD.W., KamaliA., RuberantwariA., Kengeya-KayondoJ.F., WhitworthJ.. Five year HIV-1 associated mortality in a rural Ugandan population.BMJ1997; 315: 767–71
26.
OverM., PiotP.. HIV infection and sexually transmitted diseases. In: JamisonD.T., MosleyW.H., MeashamA.R., BobadillaJ.L., eds. Disease Control Priorities in Developing Countries.New York: Oxford University Press for the World Bank, 1993: 455–527.
27.
GarnettG.P., AralS.O., HoyleD.V., CatesW., AndersonR.M.. The natural history of syphilis: implications for the transmission dynamics and control of infection.Sex Transm Dis1997; 24: 185–200
28.
HayesR.J., SchulzK.F., PlummerF.A.. The cofactor effect of genital ulcers on the per-exposure risk of HIV transmission in sub-Saharan Africa.J Trop Med Hyg1995; 98: 1–8
29.
LagaM., ManokaA., KivuvuM.. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study.AIDS1993; 7: 95–102
30.
AnzalaO.A., NagelkerkeN.J.D., BwayoJ.J.. Rapid progression to disease in African sex workers with human immunodeficiency virus type 1 infection.J Infect Dis1995; 171: 686–9
31.
ClarkS.J., SaagM.S., DeckerW.D.. High titres of cytopathic virus in plasma of patients with symptomatic primary HIV-1 infection.N Engl J Med1991; 324: 954–60
32.
ConnorR.I., MohriH., CaoY., HoD.D.. Increased viral burden and cytopathicity correlate temporally with CD4+ T-lymphocyte decline and clinical progression in human immunodeficiency virus type-1 infected individuals.J Virol1993; 67: 1772–7
33.
DaarE.S., MoudgilT., MeyerR.D., HoD.D.. Transient high levels of viraemia in patients with primary human immunodeficiency virus type 1 infection.N Engl J Med1991; 324: 961–4
34.
de VincenziI.. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners.N Engl J Med1994; 331: 341–6
35.
JacquezJ.A., KoopmanJ.S., SimonC.P., LonginiI.M.. Role of the primary infection in epidemics of HIV infection in gay cohorts.J AIDS1994; 7: 1169–84
36.
JohnG.C., KreissJ.. Mother-to-child transmission of human immunodeficiency virus type 1.Epidemiol Rev1996; 18: 149–57
37.
RobinsonN.J., AuvertB., MulderD., HayesR.. Home testing for HIV (letter).Lancet1994; 343: 1294
38.
MastroT.D., de VincenziI.. Probabilities of sexual HIV-1 transmission.AIDS1996; 10: (suppl A): S75–82
39.
Downs AM, de Vincenzi I for the European study group in heterosexual transmission of HIV.Probability of heterosexual transmission of HIV: relationship to the number of unprotected sexual contacts.J AIDS1996; 11: 388–95
40.
NunnA.J., MulderD.W., KamaliA., Kengeya-KayondoJ-F, WhitworthJ.A.G.. HIV-1 incidence in sub-Saharan Africa (letter).Lancet1996; 348: 833–4
41.
MorrisM., KretzschmarM.. Concurrent partnerships and the spread of HIV.AIDS1997; 11: 641–8
42.
GarnettG.P., JohnsonA.M.. Coining a new term in epidemiology: concurrency and HIV.AIDS1997; 11: 681–3
43.
WiwatR., HanenbergR.. The 100% condom programme in Thailand.AIDS1996; 10: 1–7
44.
HanenbergR.S., RojanapithayakornW., KunasolP., SokalD.C.. Impact of Thailand's HIV control programme as indicated by the decline of sexually transmitted diseases.Lancet1994; 344: 243–5
45.
RobinsonN.J., HanenbergR.. Condoms used during most commercial sex acts in Thailand (letter).AIDS1997; 11: 1064–5
46.
RobinsonN.J., SilarugN., SurasiengsunkS., AuvertB., HanenbergR.. Two million HIV infections prevented in Thailand: estimate of the impact of increased condom use (Abstract Mo.C.904). XI International AIDS Conference, Vancouver, July 1996
47.
RobinsonN.J., MulderD.W., AuvertB., HayesR.J.. Percentage of HIV infections attributed to one-off, short-term and long-term sexual partnerships in rural Uganda (Abstract WeC204). IX International Conference on AIDS and STD in Africa, Kampala, December 1995
48.
MorganD., MalambaS.S., MaudeG.H.. An HIV-1 natural history cohort and survival times in rural Uganda.AIDS1997; 11: 633–40
49.
CohenM.S., HoffmanI.F., RoyceR.A.. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1.Lancet1997; 349: 1868–73
50.
HoffmanI., MaidaM., RoyceR.. Effects of urethritis therapy on the concentration of HIV-1 in seminal plasma (Abstract Mo.C.903). XI International AIDS Conference, Vancouver, July 1996
