Reported behaviour does not map exactly onto identity groups however, with some insertive acts reported by Kothis and some receptive acts reported by Bisexuals and Panthis Phillips et al. Similarly, if individuals fluctuate between taking the insertive and receptive roles, this can increase HIV prevalence Alam et al. If the total numbers of insertive and receptive acts in the whole population balance, then: This is because when there is high role segregation, men consistently taking the receptive role have a high risk of acquiring infection but a low risk of transmitting, whereas when there is little role segregation, individuals acquiring HIV through receptive acts are more likely to transmit infection through taking the insertive role in some subsequent sexual encounters Goodreau et al. We extended previous models of MSM role segregation to allow each of the identity groups to have both insertive and receptive acts, in differing ratios, in line with field data. A simple model was used to obtain insights into the relationship between the degree of within-group mixing, R0 and equilibrium HIV prevalence under different mixing scenarios. Find articles by J. In models of heterosexual STI transmission, simple and transparent methods for balancing sex acts have been developed Garnett and Anderson, ; Gupta et al. Data sources The data were collected from MSM in Bangalore for evaluation of the Avahan intervention, an HIV prevention program targeted at vulnerable groups in six high prevalence states in India Chandrasekaran et al.
If the total numbers of insertive and receptive acts in the whole population balance, then: However, balancing and determining mixing in models including MSM role segregation is more complex and a variety of methods have been used for different settings Alam et al. An oral pre-exposure prophylaxis PrEP intervention was modelled, targeted at the different identity groups. This article has been cited by other articles in PMC. Note that there is considerable uncertainty in these metrics, particularly the population sizes, which is taken into account in the analyses. Hence it is likely that considerable role segregation occurs among MSM in India. When the complex model was fit to HIV prevalence data, large differences in the level of assortative mixing were seen between the fits identified using different mixing scenarios, but little difference was projected in future HIV prevalence trends. Mathematical model, Mixing matrix, Sexually transmitted infection, Disassortative mixing, Pre-exposure prophylaxis 1. Limited data are currently available on mixing between these different identity groups in India. This study explores how different possible mixing scenarios, consistent with behavioural data collected in Bangalore, south India, affect both the HIV epidemic, and the impact of a targeted intervention. Watts Find articles by C. Historical condom use trends were based upon a statistical analysis of data from the IBBA survey on how long MSM had been having sex with men and how long they had always used condoms with male sex partners, which was used to reconstruct the trend in consistent condom use over time Lowndes et al. Abstract In India, the identity of men who have sex with men MSM is closely related to the role taken in anal sex insertive, receptive or both , but little is known about sexual mixing between identity groups. Reported behaviour does not map exactly onto identity groups however, with some insertive acts reported by Kothis and some receptive acts reported by Bisexuals and Panthis Phillips et al. The size of the PB population could thus be estimated by subtracting the sizes of the KH and DD populations from the total population size. We also explore the implications of these different mixing scenarios for estimating the impact of a targeted HIV intervention after fitting a dynamic HIV transmission model incorporating these mixing assumptions to data from Bangalore. Balancing was achieved by altering the PB population size for which no data are available to give an equal number of insertive and receptive acts across the whole population. Mixing was determined within the constraints of group-specific data on group size, frequency of anal sex, and proportion of acts which are insertive. A simple model was used to obtain insights into the relationship between the degree of within-group mixing, R0 and equilibrium HIV prevalence under different mixing scenarios. Introduction For men who have sex with men MSM , taking the receptive role in anal sex carries a higher risk of acquiring HIV from an infected partner than taking the insertive role Jin et al. Disassortative mixing is defined as preferentially mixing with other groups rather than with your own group. Boily Find articles by M. A more complex, extended version of the model was used to compare the predicted HIV prevalence trends and impact of an HIV intervention when fitted to data from Bangalore. In some countries, MSM sexual identity is related to the role taken in anal sex Goodreau et al. Moses Find articles by S. The models were used to explore four different mixing scenarios ranging from assortative maximising within-group mixing to disassortative minimising within-group mixing.
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