Simulations of the HIV Epidemic in Sub-Saharan Africa: Sexual Transmission Versus Transmission Through Unsafe Medical Injections

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Abstract
Heterosexual transmission has long been considered the predominant route of transmission of HIV-1 in sub-Saharan Africa. However, some have argued that unsafe medical injections account for the majority of transmission in this region. The goal of this study was to compare the HIV-1 epidemics associated with different transmission routes. An age-structured deterministic compartmental model of HIV-1 transmission through both sexual contact and unsafe injections was developed and simulations of sexual transmission and iatrogenic transmission were compared with observed prevalence. Iatrogenic transmission probabilities and numbers of unsafe injections required to generate observed prevalence are unfeasibly high. Simulations of sexually transmitted HIV-1 generate observed prevalence using transmission probabilities and average partner change rates that are within plausible bounds. Heterosexual transmission seems a more likely route of transmission in the region. However, heterogeneity in contact patterns is of key importance. Further information on groups who are likely to receive more injections is required.