The core group revisited: the effect of partner mixing and migration on the spread of gonorrhea, Chlamydia, and HIV.

A set of differential equations are used to model the spread of sexually transmitted diseases (STDs) in a one-sex population that includes a core group of highly sexually active subjects. The effects of partner mixing between groups and migration to and from the core on the equilibrium number of infected are shown for gonorrhea, chlamydia, and HIV. The STDs are described by the transmission probability per sexual contact and the duration of infectiousness. Partner change and intercourse frequencies are estimated from sexual survey data on heterosexual behavior. The core group is small (3% of the total population) with a partner change frequency 15 times and an intercourse frequency 2 times that of the remaining population. The degree of partner mixing and migration between the two groups can be varied. The number of sexual contacts in the three types of partnerships (core-core, "mixed," remaining population-remaining population) is also modeled. The mixed partnerships are assumed to be casual and to have a low frequency of intercourse. The model is fairly simple, and the emphasis is on qualitative rather that predictive results. The effects of partner mixing are found to be strikingly different for gonorrhea, chlamydia, and HIV. With increasing partner mixing between groups, gonorrhea shows a small increase and then a decrease in the total number of infected, whereas chlamydial infection shows a strong increase. For HIV infection the effect depends on the transmission probability; when it is 0.001 per sexual contact, the number of infected with HIV is almost unaffected by the partner mixing, and when the transmission probability is 0.002 per sexual contact, there is a strong increase in the number of HIV infected with increasing partner mixing. The effects of migration are also different for each disease. With increasing migration between groups, gonorrhea is almost unaffected in the total number of infected, whereas chlamydial infection shows a strong increase. For HIV the effect again depends on the transmission probability; when it is 0.001 per sexual contact, the number of infected with HIV shows a strong decrease, and when the transmission probability is 0.002 per sexual contact the number of HIV infected reaches its maximum for medium strong migration. A sensitivity analysis shows that for all three diseases the basic reproductive ratios (R0) and the total number of infected are sensitive to duration of infectiousness. In addition, for gonorrhea and chlamydia, RO is sensitive to the partner change rates in the core, whereas for HIV, RO is sensitive to the frequency of intercourse in the core.(ABSTRACT TRUNCATED AT 400 WORDS)