Modelling Sexual Interactions : Sexual behaviour and the spread of sexually transmitted infections on dynamic networks

Abstract: In this thesis we develop statistical and mathematical models to study different factors of relevance for the spread of sexually transmitted infections (STIs). Two special interest groups for STI interventions are considered: sexually active youths and men who have sex with men (MSM). The statistical models developed make it possible to estimate individuals’ dispositions towards sexual behaviours related to the spread of STIs: condom use and anal sex. To study the spread of an infection in a population we use mathematical models. The mathematical models in this thesis give insights into the transmission process of HIV among MSM in Sweden—a population at high risk for HIV infection.The focus of the first paper is on mechanisms giving rise to observed sexual behaviour, such as condom use, among sexually active youths in Sweden. We study the sexual dispositions of individuals and how these interact and generate the observed sexual outcomes.The second paper concerns the sexual behaviour of MSM in Sweden and the transmission process of HIV within this population. The population is modelled by a stochastic dynamic network model that incorporates both steady partnerships and casual contacts. We model the spread of an infection where individuals are susceptible, infectious or diagnosed (unable to transmit) and derive the basic reproduction number R0, the probability of a major outbreak, and the endemic prevalence.The third paper further develops the dynamic network model of the second paper. The model now takes into account that individuals may be sexually high-active or sexually low-active. The division into two activity groups makes it possible to study a preventive intervention against HIV that is only targeted to sexually high-active. The intervention studied is pre-exposure prophylaxis for HIV (PrEP), i.e. that the antiviral drugs tenofovir-emtricitabine are taken by individuals with negative HIV serostatus to prevent getting infected by HIV. We study the PrEP coverage needed to reduce the observed HIV prevalence of 5% to a value close to 0%.In the fourth and final paper we focus on condom dispositions among MSM. The disposition models from the first paper are extended to better fit an MSM population and are additionally extended to be used for more types of sexual behaviour data.