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The HIV transmission gradient: relationship patterns of protection

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Abstract

We describe a gradient of potential HIV transmission from HIV-infected persons to their partners and thence to uninfected populations. The effect of this newly discovered transmission gradient is to limit the spread of HIV. We roughly estimate a 2% long-term transmission probability for sex and 14% for drug injection for two-step transmission. Then we test theories to account for this pattern on a network sample of 267 inner city drug users and nonusers. Although HIV positive persons engaged in a high level of risk with one another, they engaged in less risk with HIV negative partners, and these partners engaged in even lower levels of risk with other HIV negative persons. Analyses suggest that the primary motivation for sexual risk reduction is partner protection, while emotional closeness is the major barrier. Hypotheses accounting for risk in terms of self protection, social norms, gender power, and drug use were weakly supported or unsupported.

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Notes

  1. “Index” is a term common in network studies to refer to the first recruited member of a social network. A “risk partner” is a person named by the index participant as a sex or drug injection partner in the previous 30 days.

  2. We made the decision to include non-risk partners in the gatekeeper group because relationships are not static. Thus each gatekeeper may be a past or potential future risk partner. In analyses later in this paper where we examine predictors of sex risks, we exclude all non-sex relationships from analyses.

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Acknowledgments

Work on this paper was supported in part by Grant DA08989 from the National Institute on Drug Abuse, principal investigators Isaac D. Montoya and David C. Bell. The analyses for this paper were completed while the authors were employed by Affiliated Systems Corporation, a think tank in Houston, Texas. The authors would like to thank Sam Friedman, Seth Kalichman, Martina Morris, Jon Potterat, and anonymous reviewers for their insightful critiques of an earlier version of this paper, and Swati Sheth and Travis Cal for assistance in the preparation of this paper. Opinions expressed herein are solely those of the authors.

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Bell, D.C., Atkinson, J.S., Mosier, V. et al. The HIV transmission gradient: relationship patterns of protection. AIDS Behav 11, 789–811 (2007). https://doi.org/10.1007/s10461-006-9192-5

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