Linearity and nonlinearity in HIV/STI transmission: Implications for the evaluation of sexual risk reduction interventions

Steven D. Pinkerton, Harrell W. Chesson, Richard A. Crosby, Peter M. Layde

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

A mathematical model of HIV/sexually transmitted infections (STI) transmission was used to examine how linearity or nonlinearity in the relationship between the number of unprotected sex acts (or the number of sex partners) and the risk of acquiring HIV or a highly infectious STI (such as gonorrhea or chlamydia) affects the utility of sexual behavior change measures as indicators of the effectiveness of HIV/STI risk-reduction interventions. Findings indicate that the risk of acquiring HIV through vaginal intercourse is essentially a linear function of the number of unprotected sex acts and is nearly independent of the number of sex partners. Consequently, the number of unprotected sex acts is an excellent marker for the risk of acquiring HIV through vaginal intercourse, whereas the number of sex partners is largely uninformative. In general, the number of unprotected sex acts is not an adequate marker for the risk of acquiring a highly infectious STI due to the highly nonlinear per act transmission dynamics of these STIs. The number of sex partners is a reasonable indicator of STI risk only under highly circumscribed conditions. A theoretical explanation for this pattern of results is provided. The contrasting extent to which HIV and highly infectious STIs deviate from the linearity assumption that underlies sexual behavior outcome measures has important implications for the use of these measures to assess the effectiveness of HIV/STI risk-reduction interventions.

Original languageEnglish
Pages (from-to)550-565
Number of pages16
JournalEvaluation Review
Volume35
Issue number5
DOIs
StatePublished - Oct 2011

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research was supported by grants R01-MH72474 and P30-MH52776 from the National Institute of Mental Health.

Keywords

  • design and evaluation of programs and policies
  • measurement
  • methodology (if appropriate)
  • outcome evaluation (other than economic evaluation)

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • General Social Sciences

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