Sexual networks and the transmission of HIV in London

Department of Epidemiology and Public Health, Imperial College of Science, Technology and Medicine, University of London, UK.
Journal of Biosocial Science (Impact Factor: 0.98). 02/1998; 30(1):63-83. DOI: 10.1017/S0021932098000637
Source: PubMed


This paper discusses ways in which empirical research investigating sexual networks can further understanding of the transmission of HIV in London, using information from a 24-month period of participant observation and 53 open-ended, in-depth interviews with eighteen men and one woman who have direct and indirect sexual links with each other. These interviews enabled the identification of a wider sexual network between 154 participants and contacts during the year August 1994-July 1995. The linked network data help to identify pathways of transmission between individuals who are HIV+ and those who are HIV-, as well as sexual links between 'older' and 'younger' men, and with male prostitutes. There appears to be considerable on-going transmission of HIV in London. The majority of participants reported having had unprotected anal and/or vaginal sex within a variety of relationships. The implications of these findings for policies designed to prevent the transmission of HIV are discussed.

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Available from: Helen Ward, Jan 07, 2014
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    • "More work is also needed to understand the network structure underlying a particular epidemic in a particular population. Some limited work has been done to characterize specific networks of infectious disease (e.g., Klovdahl et al. [34], Weeks et al. [35], Parker et al. [36], Helleringer et al. [37]). Further knowledge of network structure, and related disease transmission features such as pair formation and dissolution, is crucial to evaluating the effectiveness, and cost-effectiveness, of different investments in contact tracing in any given setting. "
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    ABSTRACT: Contact tracing (also known as partner notification) is a primary means of controlling infectious diseases such as tuberculosis (TB), human immunodeficiency virus (HIV), and sexually transmitted diseases (STDs). However, little work has been done to determine the optimal level of investment in contact tracing. In this paper, we present a methodology for evaluating the appropriate level of investment in contact tracing. We develop and apply a simulation model of contact tracing and the spread of an infectious disease among a network of individuals in order to evaluate the cost and effectiveness of different levels of contact tracing. We show that contact tracing is likely to have diminishing returns to scale in investment: incremental investments in contact tracing yield diminishing reductions in disease prevalence. In conjunction with a cost-effectiveness threshold, we then determine the optimal amount that should be invested in contact tracing. We first assume that the only incremental disease control is contact tracing. We then extend the analysis to consider the optimal allocation of a budget between contact tracing and screening for exogenous infection, and between contact tracing and screening for endogenous infection. We discuss how a simulation model of this type, appropriately tailored, could be used as a policy tool for determining the appropriate level of investment in contact tracing for a specific disease in a specific population. We present an example application to contact tracing for chlamydia control.
    Health Care Management Science 01/2008; 10(4):341-55. DOI:10.1007/s10729-007-9027-6 · 1.05 Impact Factor
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    • "This research entailed participant observation fieldwork in a wide range of settings (including a clinic for sexually transmitted diseases, the flats and houses of informants as well as a variety of bars, pubs, clubs and cafes); and a total of 57 open-ended, unstructured interviews were undertaken with one woman and nineteen men. These informants were all linked to each other through a variety of sexual links, and the way in which these links were identified has been discussed in detail in Parker et al. (1998). Briefly, two methods were used to identify sexual and social links: clinic referrals at a London teaching hospital and snowball sampling. "
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    ABSTRACT: A growing and substantial body of research suggests that female sex workers play a disproportionately large role in the transmission of HIV in many parts of the world, and they are often referred to as core groups by epidemiologists, mathematical modellers, clinicians and policymakers. Male sex workers, by contrast, have received little attention and it is not known whether it is helpful to conceptualize them as a core group. This paper draws upon ethnographic research documenting social and sexual networks in London and looks at the position of five male sex workers within a network comprising 193 men and seven women (as well as 1378 anonymous sexual contacts and 780 commercial contacts). In so doing, it suggests that there is no evidence to show that male sex workers are more or less likely to acquire or transmit HIV in the course of commercial sex compared with other types of sexual relationships. In addition, men engaging in non-commercial sex all reported having unprotected sex in a variety of contexts and relationships and there is no evidence to suggest that men who are not sex workers play less of a role in the transmission of HIV. In short, these data suggest that it would be inappropriate to conceptualize male sex workers as a core group. This is not to suggest that public policy should continue to overlook male sex workers. New and inventive approaches are required to reach out to a vulnerable but diverse group of men, selling sex for a variety of reasons; even if these men are no more vulnerable to acquiring and/or transmitting HIV than other men and women that form part of their network.
    Journal of Biosocial Science 02/2006; 38(1):117-31. DOI:10.1017/S0021932005001136 · 0.98 Impact Factor
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    ABSTRACT: This phenomenological study explores the experience of male sex-workers. The aim of this study was to contribute to the knowledge and understanding of this complex phenomenon and hopefully serve as a foundation for future research and counselling interventions in this field. A comprehensive literature review examining the individual and contextual issues rooted in the world of commercial sex between men is provided, and forms a firm foundation and backdrop for this study. The design of this study was qualitative and proceeded from a phenomenological stance. Data was collected through in-depth, unstructured interviews with four, white South African men who were currently working as male prostitutes. The interviews were recorded on audiotape and transcribed verbatim for each participant. The data was then categorized, coded and analyzed inter-individually in order to discover common and contrasting themes and patterns. These were tied together to form a hypothetical and general description of the experience of the male sex-worker. Submitted in partial fulfillment of the requirements for the degree of Master of Arts (Counselling Psychology) in the Department of Psychology University of Zululand, 2003.
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