Volume 33 - Article 15 | Pages 425–450  

Sexual networks, partnership mixing, and the female-to-male ratio of HIV infections in generalized epidemics: An agent-based simulation study

By Georges Reniers, Benjamin Armbruster, Aaron Lucas

Abstract

Background: Empirical estimates of the female-to-male ratio of infections in generalized HIV epidemics in sub-Saharan Africa range from 1.31 in Zambia to 2.21 in Ivory Coast. Inequalities in the gender ratio of infections can arise because of differences in exposure (to HIV-positive partners), susceptibility (given exposure), and survival (once infected). Differences in susceptibility have to date received most attention, but neither the relatively high gender ratio of infections nor the heterogeneity in empirical estimates is fully understood.

Objective: Demonstrate the relevance of partnership network attributes and sexual mixing patterns to gender differences in the exposure to HIV-positive partners and the gender ratio of infections.

Methods: Agent-based simulation model built in NetLogo.

Results: The female-to-male ratio of infections predicted by our model ranges from 1.13 to 1.75. Gender-asymmetric partnership concurrency, rapid partnership turnover, elevated partnership dissolution in female-positive serodiscordant couples, and lower partnership re-entry rates among HIV-positive women can produce (substantial) differences in the gender ratio of infections. Coital dilution and serosorting have modest moderating effects.

Conclusions: Partnership network attributes and sexual mixing patterns can have a considerable effect on the gender ratio of HIV infections. We need to look beyond individual behavior and gender differences in biological susceptibility if we are to fully understand, and remedy, gender inequalities in HIV infection in generalized epidemics.

Author's Affiliation

Other articles by the same author/authors in Demographic Research

Knowledge, risk perceptions, and behaviors related to the COVID-19 pandemic in Malawi
Volume 44 - Article 20

Age patterns of under-5 mortality in sub-Saharan Africa during 1990‒2018: A comparison of estimates from demographic surveillance with full birth histories and the historic record
Volume 44 - Article 18

Polygyny and HIV in Malawi
Volume 19 - Article 53

Divorce and Remarriage in Rural Malawi
Special Collection 1 - Article 6

An Assessment of the KDICP and MDICP Data Quality: Interviewer Effects, Question Reliability and Sample Attrition
Special Collection 1 - Article 2

Most recent similar articles in Demographic Research

Ultra-Orthodox fertility and marriage in the United States: Evidence from the American Community Survey
Volume 49 - Article 29    | Keywords: age at first marriage, American Community Survey (ACS), fertility, Judaism, marriage, religion, total fertility rate (TFR), Ultra-Orthodox Judaism

Variable-r in sex ratios: Formulas in honor of Jim Vaupel
Volume 49 - Article 26    | Keywords: cohort analysis, growth rate, sex ratio, variable-r method

The dynamic role of household structure on under-5 mortality in southern and eastern sub-Saharan Africa
Volume 49 - Article 11    | Keywords: child mortality, Health and Demographic Surveillance System, household structure, sub-Saharan Africa

Comparative evidence of years lived with reproductive-age morbidity in sub-Saharan Africa (2010‒2019)
Volume 49 - Article 6    | Keywords: life expectancy, maternal morbidities, reproductive age, sub-Saharan Africa

Subnational variations in births and marriages during the COVID-19 pandemic in South Korea
Volume 48 - Article 30    | Keywords: COVID-19, fertility, Korea, marriage