IDU Heterosexual relationship MAP 2002

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Relationship of IDU and general population epidemics in Asian Settings: 

Relationship of IDU and general population epidemics in Asian Settings Presented by Wiwat Peerapatanapokin Barcelona MAP Symposium 3 July 2002 Studied by Tobi J. Saidel, Family Health International Don Des Jarlais, Beth Israel Medical Center Wiwat Peerapatanapokin, East West Cemter Tim Brown, East West Center Jimmy Dorabjee, SHARAN Siddharth Singh, SHARAN Supported by Family Health International

Sexual context in Asia: 

Sexual context in Asia Low risk females Clients Low risk males IDUs FSW Does IDU epidemic influence heterosexual epidemic? What is the magnitude of this influence?

The Asian Epidemic Model (AEM): 

The Asian Epidemic Model (AEM) Developed by East-West Center. The original model was funded by USAIDS. Focuses on replicating the dynamics of HIV epidemics in Asian settings Simple model with four transmission routes: sex work needle sharing Pre- extra- and intra-marital sex mother to child transmission The sizes of epidemiologically important populations and risk behaviors (e.g., condom use or frequency of sex) are provided as inputs to the model. Inputs can be varied by year The model then calculates epidemiological trends over time

Slide4: 

Uninfected X1 Infected Y1 Male Clients Uninfected X2 Infected Y2 Male Non-client Death Death Death Death 15 Years Old Male AEM Heterosexual Model for the Population Movement Movement Uninfected X4 Infected Y4 General Female Death Death Death Death Movement Movement 15 Years Old Female Female Sex worker Uninfected Infected Direct Indirect

Slide5: 

HIV Model : Intravenous Drug User Uninfected X6 Infected Y6 Non-Sharing IDU Death Death Migration Migration Uninfected X5 Infected Y5 Significant-Sharing IDU Death Death General Male Uninfected X1 + X2 General Male Infected Y1 + Y2

Slide6: 

Movement of Uninfected Female Sex Workers - Death Infected from non-IDU male clients Infected from IDU male clients + Migrate in from general females - Migrate out to general females = Movement of Uninfected Female Sex Workers ( X3 ) Uninfected Female Sex Worker ( X3 ) Infected Female Sex Worker ( Y3 ) Death Uninfected General Female ( X4 )

Slide7: 

- Death - Infected from needle-sharing - Infected from sex workers + Migrate in from general males - Migrate out to general males + Migrate in from non-sharing IDUs - Migrate out to non-sharing IDUs Movement of Uninfected Significant-Sharing IDUs ( X5 ) = Movement of uninfected significant-sharing IDUs Uninfected Significant-Sharing IDUs ( X5 ) Infected Significant-Sharing IDUs ( Y5 ) Death Uninfected General Males (X1+ X2 ) Uninfected Non-Sharing IDUs ( X6)

Slide8: 

Direct and indirect sex workers General population males General population females AEM Fit for Thailand White lines are HIV trends from observed data Colored lines are AEM generated HIV trends Injecting Drug Users

Slide9: 

AEM Fit for Cambodia

Objective: 

Objective To examine the influence of IDUs on heterosexual spread of HIV under varying epidemiologic conditions

Methods: 

Methods Used Asian Epidemic Model (AEM) to examine the influence of IDUs on heterosexual spread of HIV Inputs are hypothetical data based on data in a city of India Three Heterosexual epidemics were examined Low Uncontrolled Advance Uncontrolled Controlled

Key Inputs for AEM : 

Key Inputs for AEM Population Sizes Total adult in 2000 = 11 millions IDUs = 38,000 Direct sex workers = 7,000 Indirect sex workers = 11,000 % Male visit sex workers = 10% % IDUs visit sex workers = 10% Assume no female sex worker inject drug

Low Heterosexual epidemic: 

Low Heterosexual epidemic Last time condom use among direct SWs = 30% STD among Direct SWs = 16% Look at the impact of IDUs in different prevalence Very Low (near 0%) Low (5%) High (60%) Very High (90%)

Advance Heterosexual epidemic: 

Advance Heterosexual epidemic Last time condom use among direct SWs = 10% at beginning and 40% at the late epidemic STD among Direct SWs = 50% at the beginning and 20% at the late epidemic Look at the impact of IDUs in different prevalence Very Low (near 0%) Low (5%) High (60%) Very High (90%)

Controlled Heterosexual epidemic: 

Controlled Heterosexual epidemic Last time condom use among direct SWs = 15% at beginning and 85% at the late epidemic STD among Direct SWs = 50% at the beginning and 10% at the late epidemic Look at the impact of IDUs in different prevalence Very Low (near 0%) Low (5%) High (60%) Very High (90%)

Patterns of HIV prevalence among Sex Workers in different types of Heterosexual Epidemic Setting (without IDU impact): 

Patterns of HIV prevalence among Sex Workers in different types of Heterosexual Epidemic Setting (without IDU impact) Low Uncontrolled High Uncontrolled Controlled Philippines Bangkladesh Mumbai Thailand Cambodia

Results: 

Results

Slide18: 

Low Uncontrolled Heterosexual Epidemic – Without IDU Impact

Slide19: 

Low Uncontrolled Heterosexual Epidemic – With IDU Impact

IDU impacts on Low Uncontrolled Heterosexual Epidemic : 

IDU impacts on Low Uncontrolled Heterosexual Epidemic IDU HIV Prevalences IDU Start 1990

Slide21: 

Advance Uncontrolled Heterosexual Epidemic – Without IDU Impact

Slide22: 

Advance Uncontrolled Heterosexual Epidemic – With IDU Impact

IDU impacts on Advance Uncontrolled Heterosexual Epidemic : 

IDU impacts on Advance Uncontrolled Heterosexual Epidemic IDU HIV Prevalences IDU Start 1995

Slide24: 

Controlled Heterosexual Epidemic – Without IDU Impact

Slide25: 

Controlled Heterosexual Epidemic – With IDU Impact

IDU impacts on Controlled Heterosexual Epidemic : 

IDU impacts on Controlled Heterosexual Epidemic IDU HIV Prevalences IDU Start 2000

Conclusions: 

Conclusions IDU epidemic can influence all settings of heterosexual epidemics It can have huge impact on the early stage of heterosexual. It also accelerates the beginning time of heterosexual epidemic.

Thank you: 

Thank you

Slide29: 

Impact of IDU in different epidemic settings

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