Using data from 'visible' populations to estimate the size and importance of 'hidden' populations in an epidemic: A modelling technique.
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
We used reported behavioural data from cisgender men who have sex with men and transgender women (MSM/TGW) in Bangalore, mainly collected from 'hot-spot' locations that attract MSM/TGW, to illustrate a technique to deal with potential issues with the representativeness of this sample. A deterministic dynamic model of HIV transmission was developed, incorporating three subgroups of MSM/TGW, grouped according to their reported predominant sexual role (insertive, receptive or versatile). Using mathematical modelling and data triangulation for 'balancing' numbers of partners and role preferences, we compared three different approaches to determine if our technique could be useful for inferring characteristics of a more 'hidden' insertive MSM subpopulation, and explored their potential importance for the HIV epidemic. Projections for 2009 across all three approaches suggest that HIV prevalence among insertive MSM was likely to be less than half that recorded in the surveys (4.5-6.5% versus 13.1%), but that the relative size of this subgroup was over four times larger (61-69% of all MSM/TGW versus 15%). We infer that the insertive MSM accounted for 10-20% of all prevalent HIV infections among urban males aged 15-49. Mathematical modelling can be used with data on 'visible' MSM/TGW to provide insights into the characteristics of 'hidden' MSM. A greater understanding of the sexual behaviour of all MSM/TGW is important for effective HIV programming. More broadly, a hidden subgroup with a lower infectious disease prevalence than more visible subgroups, has the potential to contain more infections, if the hidden subgroup is considerably larger in size.
Date Issued
2020-09-30
Date Acceptance
2020-09-24
Citation
Infectious Disease Modelling, 2020, 5, pp.798-813
ISSN
2468-2152
Publisher
Keai Publishing
Start Page
798
End Page
813
Journal / Book Title
Infectious Disease Modelling
Volume
5
Copyright Statement
© 2020 The Authors. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the
CC BY license (http://creativecommons.org/licenses/by/4.0/).
CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Sponsor
Bill & Melinda Gates Foundation
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33102985
PII: S2468-0427(20)30052-X
Grant Number
n/a
Subjects
ART, antiretroviral therapy
FSW, female sex worker
HIV
IBBA, integrated biological and behavioural assessment survey
India
Infectious diseases
MSM/TGW, cisgender men or transgender women, who have sex with cisgender men or transgender women
Mathematical modelling
Men who have sex with men
PB, panthis and bisexuals
SBS, special behavioural survey
Transgender women
Publication Status
Published
Coverage Spatial
China
Date Publish Online
2020-09-30