HIV and Concurrent Sexual Partnerships: Modeling the Role of Coital Dilution

Abstract

Background: The concurrency hypothesis asserts that high prevalence of long-term, overlapping sexual partnerships explains extraordinarily high HIV levels in sub-Saharan Africa. Earlier simulation models show that the network effect of concurrency can increase HIV incidence, but these models do not account for the coital dilution effect (non-primary partnerships have lower coital frequency than primary partnerships). Methods: We modify the model of Eaton et al. (AIDS and Behavior September 2010) to incorporate coital dilution by assigning lower coital frequencies to non-primary partnerships. We parameterize coital dilution based on the empirical work of Morris et al. (PLoS ONE December 2010) and others. Following Eaton et al., we simulate the daily transmission of HIV over 250 years for 10 levels of concurrency. Results: At every level of concurrency, our focal coital-dilution simulation produces epidemic extinction. Our sensitivity analysis shows that this result is quite robust; even modestly lower coital frequencies in non-primary partnerships lead to epidemic extinction.Conclusion: In order to contribute usefully to the investigation of HIV prevalence, simulation models of concurrent partnering and HIV epidemics must incorporate realistic degrees of coital dilution. Doing so dramatically reduces the role that concurrency can play in accelerating the spread of HIV and suggests that concurrency cannot be an important driver of HIV epidemics in sub-Saharan Africa. Alternative explanations for HIV epidemics in sub-Saharan Africa are needed.