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Behavioral Research and STIs

Behavioral Research and STIs. Objectives Discuss how behavior influences the basic reproductive rate of an epidemic Describe some of the behavioral models Discuss the concept of Core Group Discuss Social Network Analysis. Behavioral versus Clinical. Basic Reproductive Rate of Infection.

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Behavioral Research and STIs

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  1. Behavioral Research and STIs Objectives • Discuss how behavior influences the basic reproductive rate of an epidemic • Describe some of the behavioral models • Discuss the concept of Core Group • Discuss Social Network Analysis

  2. Behavioral versus Clinical

  3. Basic Reproductive Rate of Infection

  4. The Reproductive Rate Ro > 1 epidemic Ro = 1 equilibrium Ro < 1 prevalence declines

  5. Ro basic reproductive rate • Defines the average number of secondary infections generated by one primary case in a susceptible population of defined density • the host population is divided into compartments: susceptibles, infected (latent), and infectious

  6. ()Transmission Probability • infected and susceptible • number of partners • types of partners • types of sexual acts • frequency of sexual acts • virulence of infection • duration of infection • when infection occurred • when infection was treated

  7. Sexual Risk Behavior (Aral, 194) • Age at sexual debut • Number of sex partners • Non-discriminating sex partner recruitment • Sexual practices • Frequency of intercourse • Intercourse during menses • Condom use • Vaginal douching • Male circumcision

  8. Behavioral Models of Disease

  9. Trait Concept • Antisocial personality • Chronic self-destructiveness • Erotophobia-erotophilia • Impulsivity • Independence-conformity • Locus of control • Masculinity-femininity • Neuroticism-extraversion-psychoticism

  10. Trait Concept • Risk taking • Self-efficacy • Self-esteem • Self-monitoring • Sensation seeking • Sex guilt • Social desirability

  11. D - the Infectious Period

  12. c - mean rate of sexual partner change • depends on demographic and social factors • magnitudes are correlated with other factors such as number of sex acts, type of sexual contacts and mixing. • Does a Core Group exist?

  13. Core Group

  14. Core Group(Thomas and Tucker, 1996) • Defined as: People who infected a large proportion of the time, infect more than one other person, are repeatedly infected, are prostitutes or their clients, geographic areas with large numbers of cases • Mathematical • Clinical-epidemiologic • sociocultural

  15. Definitions applied to Core Group (Thomas and Tucker, 1996) • Groups whose prevalence of GC is > 20% • Prostitutes • Persons who have many sexual contacts • very sexually active persons who are asymptomatic when infectious • people repeated infected with STD • people with > 5 sex partners • people with clusters of high-risk behavior • adolescent males in detention • census tracts that are responsible for > 50% of cases

  16. Social Network Analysis

  17. Linear Concept of transmission of an STD

  18. Network informed concept of disease transmission

  19. Sexual Behaviors(Aral; 1994) • Early age at sexual debut • Large number of lifetime sexual partners • Large number of current sexual partners • Non-discriminating sex partner recruitment patterns • High risk characteristics of sexual partners • Specific sexual practices • frequency and timing of sexual intercourse • Sexual abuse during childhood

  20. Health Behaviors(Aral; 1994) • Condom and Contraceptive use • Vaginal douching • Male circumcision • Health Care seeking • Compliance with therapy • Compliance with behavioral recommendations

  21. Substance Abuse(Aral; 1994) • Associated with anonymous sex • Associated with exchange for drugs or money • Reduces likelihood that safer sex will be practiced • Includes injectables, inhalables, and alcohol

  22. Transmission ProcessShiboski and Padian, JID 1996;174 Partner choice sexual contact population/ group level factors individual/ Partner level factors Transmission

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