Sexual behavior, heterosexual transmission, and the spread of HIV in sub-Saharan Africa: A simulation study

A stochastic simulation model has been used to assess the extent to which v ariation in sexual behavior and transmission characteristics can explain th e striking spatial heterogeneity in the prevalence of HIV among different g eographical locations in sub-Saharan Africa. Of the various parameters desc ribing sexual behavior the most important determinant of the spread of HIV is the proportion of men engaging in sexual relationships with people other than spouses, including contacts with sex workers and short-term partners. Considering factors other than sexual behavior the model shows that this h eterogeneity in HIV prevalence could be the result of differences in the tr ansmission probability of HIV or in the prevalence of other sexually transm itted diseases. These factors could play a key role in determining the patt erns of spread of HIV in sub-Saharan Africa and should be considered in the design of intervention strategies. (C) 2000 Academic Press.