Sexual Behavior, Risk Perception, And Hiv Transmission Can Respond To Hiv Antiviral Drugs And Vaccines Through Multiple Pathways
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Date
2015-10-28
Authors
Tully, Stephen
Cojocaru, Monica
Bauch, Chris T.
Journal Title
Journal ISSN
Volume Title
Publisher
Nature Publishing Group
Abstract
There has been growing use of highly active antiretroviral treatment (HAART) for HIV and significant progress in developing prophylactic HIV vaccines. The simplest theories of counterproductive behavioral responses to such interventions tend to focus on single feedback mechanisms: for instance, HAART optimism makes infection less scary and thus promotes risky sexual behavior. Here, we develop an agent based, age-structured model of HIV transmission, risk perception, and partner selection in a core group to explore behavioral responses to interventions. We find that interventions can activate not one, but several feedback mechanisms that could potentially influence decision-making and HIV prevalence. In the model, HAART increases the attractiveness of unprotected sex, but it also increases perceived risk of infection and, on longer timescales, causes demographic impacts that partially counteract HAART optimism. Both HAART and vaccination usually lead to lower rates of unprotected sex on the whole, but intervention effectiveness depends strongly on whether individuals over-or under-estimate intervention coverage. Age-specific effects cause sexual behavior and HIV prevalence to change in opposite ways in old and young age groups. For complex infections like HIV-where interventions influence transmission, demography, sexual behavior and risk perception-we conclude that evaluations of behavioral responses should consider multiple feedback mechanisms.
Description
Keywords
Antiretroviral Therapy, Homosexual-Men, Dynamics, Beliefs, Population, Epidemics, Hiv/Aids, Model