Skip to main content
SpringerLink
Log in

The Bernoulli-Process Model of HIV Transmission

Applications and Implications

  • Chapter
Handbook of Economic Evaluation of HIV Prevention Programs

Part of the book series: AIDS Prevention and Mental Health ((APMH))

Abstract

Evaluation of HIV prevention programs is complicated by challenges at the biomedical, societal, and individual levels. Although the transmission of HIV is a discrete event, rarely can the outcome of a particular opportunity for transmission be ascertained with certainty. When seroconversion occurs, it is delayed by several weeks or even months from the time of infection. Moreover, most cases of HIV infection are detected only much later in the course of disease progression, after the manifestation of symptoms associated with deterioration of the immune system. Because of this uncertainty, from an analytic perspective HIV transmission is best viewed as a stochastic process. Thus, we might assume that there is a certain probability of HIV transmission each time a susceptible person has unprotected sex or engages in other HIV-risk behaviors. Or instead, we might consider each new sexual relationship as posing some definite HIV risk. In either case, risk is quantified as a probability of HIV transmission. Although the focus herein is on the sexual transmission of HIV, analogous models for drug injection-related risks also exist.1,2

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Kahn JG, Washington AE, Showstack JA, Berlin M, Phillips K. Updated Estimates of the Impact and Cost of HIV Prevention in Injection Drug Users. Final report prepared for the Centers for Disease Control and Prevention. San Francisco Institute for Health Policy Studies, University of California at San Francisco; 1992.

    Google Scholar 

  2. Holtgrave DR, Pinkerton SD, Jones TS, Lurie P, Vlahov D. Cost and cost-effectiveness of increasing access to sterile syringes and needles as an HIV prevention intervention in the United States. J Acquired Immune Defic Synd Hum Retrovirol 1998; 18(Suppl. 1): S133–S138.

    Article  Google Scholar 

  3. Pinkerton SD, Holtgrave DR, Leviton L, Wagstaff D, Abramson PR. Model-based evaluation of HIV prevention interventions. Evaluation Rev 1998; 22: 155–174.

    Article  CAS  Google Scholar 

  4. Pinkerton SD, Holtgrave DR. A method for evaluating the economic efficiency of HIV behavior risk reduction interventions. AIDS and Behavior, in press.

    Google Scholar 

  5. Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost-effectiveness in Health and Medicine. New York Oxford University Press; 1996.

    Google Scholar 

  6. NIH Consensus Development Conference Consensus Statement. Interventions to Prevent HIV Risk Behaviors. Washington DC Government Printing Office; 1997.

    Google Scholar 

  7. Mastro TD, de Vincenzi I. Probabilities of sexual HIV-1 transmission. AIDS 1996; 10(Suppl. A): S75–S82.

    Article  PubMed  Google Scholar 

  8. Pinkerton SD, Abramson PR. Effectiveness of condoms in preventing HIV transmission. Soc Sci Med 1996; 44: 1303–1312.

    Article  Google Scholar 

  9. Hearst N, Hulley SB. Preventing the heterosexual spread of AIDS. JAMA 1988; 259: 2428–2432.

    Article  CAS  PubMed  Google Scholar 

  10. Pinkerton SD, Abramson PR. Evaluating the risks: A Bernoulli process model of HIV infection and risk reduction. Evaluation Rev 1993; 17: 504–528.

    Article  Google Scholar 

  11. Eisenberg B. The number of partners and the probability of HIV infection. Stat Med 1989; 8: 83–92.

    Article  CAS  PubMed  Google Scholar 

  12. Fineberg HV. Education to prevent AIDS: Prospects and obstacles. Science 1988; 239: 592–596.

    Article  CAS  PubMed  Google Scholar 

  13. Pinkerton SD, Abramson PR. Occasional condom use and HIV risk reduction. J Acquired Immune Defic Syndr Hum Retrovirol 1996; 13: 456–460.

    Article  CAS  Google Scholar 

  14. Reiss IL, Leik RK. Evaluating strategies to avoid AIDS: Number of partners vs. use of condoms. J Sex Res 1989; 26: 411–433.

    Article  Google Scholar 

  15. Blower SM, Boe C. Sex acts, sex partners, and sex budgets: Implications for risk factor analysis and estimation of HIV transmission probabilities. J Acquired Immune Defic Syndr 1993; 6: 1347–1352.

    CAS  Google Scholar 

  16. Berkowitz R, Callen M. How to Have Sex in an Epidemic. New York News from the Front Publications; 1983.

    Google Scholar 

  17. Abramson PR, Pinkerton SD. With Pleasure: Thoughts on the Nature of Human Sexuality. New York Oxford University Press; 1995.

    Google Scholar 

  18. Catania JA, Coates TJ, Stall R, Turner H, Peterson J, Hearst N, Dolcini MM, Hudes E, Gagnon J, Groves R. Prevalence of AIDS-related risk factors and condom use in the United States. Science 1992; 258: 1101–1106.

    Article  CAS  PubMed  Google Scholar 

  19. Pleck JH, Sonenstein FL, Ku LC. Adolescent males’ condom use: Relationships between perceived cost-benefits and consistency. J Marriage Family 1991; 53: 733–745.

    Article  Google Scholar 

  20. Johnson AM, Petherick A, Davidson SJ, Brettle R, Hooker M, Howard L, McLean KA, Osborne LEM, Robertson R, Connex C, Tchamouroff S, Shergold C, Adler MW. Transmission of human immunodeficiency virus to sexual partners of hemophiliacs. AIDS 1989; 3: 367–372.

    Article  CAS  PubMed  Google Scholar 

  21. Peterman TA, Stoneburner RL, Allen JR, Jaffe HW, Curran JW. Risk of human immunodeficiency virus transmission from heterosexual adults with transfusion-associated infections. JAMA 1988; 259: 55–58.

    Article  CAS  PubMed  Google Scholar 

  22. Staszewski S, Schieck E, Rehmet S, Helm EB, Stille W. HIV transmission from male after only two sexual contacts. Lancet 1987; 2: 628.

    Article  CAS  PubMed  Google Scholar 

  23. Pinkerton SD, Abramson PR. Implications of increased infectivity in early-stage HIV infection: Application of a Bernoulli-process model of HIV transmission. Evaluation Rev 1996; 20: 516–540.

    Article  CAS  Google Scholar 

  24. Wittkowski KM. Preventing the heterosexual spread of AIDS: What is the best advice if compliance is taken into account? AIDS 1988; 3: 143–145.

    Article  Google Scholar 

  25. Pinkerton SD, Abramson PR. Is risky sex rational? J Sex Res 1992; 29: 561–568.

    Article  Google Scholar 

  26. Cochran SD, Mays VM. Sex, lies, and HIV. N Engl J Med 1990; 322: 774–775.

    Article  CAS  PubMed  Google Scholar 

  27. Crimp D. How to have promiscuity in an epidemic. In Crimp D, ed. AIDS: Cultural Analysis, Cultural Activism. Cambridge, MA MIT Press; 1988.

    Google Scholar 

  28. Pinkerton SD, Abramson PR. An alternative model of the reproductive rate of HIV infection: Formulation, evaluation, and implications for risk reduction interventions. Evaluation Rev 1994; 18: 371–388.

    Article  Google Scholar 

  29. Holmberg SD. The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. Am J Public Health 1996; 86: 642–654.

    Article  CAS  PubMed  Google Scholar 

  30. Holmberg SD, Horsburgh CR Jr., Ward JW, Jaffe HW. Biologic factors in the sexual transmission of human immunodeficiency virus. J Infect Dis 1989; 160: 116–125.

    Article  CAS  PubMed  Google Scholar 

  31. Nicolosi A. Human immunodeficiency virus (HIV-1): Infectivity transmission, risk behaviours and host susceptibility. Functional Neurology 1992; 7: 13–29.

    CAS  PubMed  Google Scholar 

  32. O’Brien TR, Busch MP, Donegan E, Ward JW, Wong I, Samson SM, Perkins HA, Altman R, Stoneburner RL, Holmberg SD. Heterosexual transmission of human immunodeficiency virus type 1 from transfusion recipients to their sex partners. J Acquired Immune Defic Syndr 1994; 7: 705–710.

    Google Scholar 

  33. Royce RA, Sena A, Cates W Jr., Cohen MS. Sexual transmission of HIV. N Engl J Med 1997; 336: 1072–1078.

    Article  CAS  PubMed  Google Scholar 

  34. Jacquez JA, Koopman JS, Simon CP, Longini IM Jr. Role of primary infection in epidemics of HIV infection in gay cohorts. J Acquired Immune Defic Syndr 1994; 7: 1169–1184.

    CAS  Google Scholar 

  35. Hooper RR, Reynolds GH, Jones OG, Zaidi A, Wiesner PJ, Latimer KP, Lester A, Campbell AF, Harrison WO, Karney WW, Holmes KK. Cohort study of venereal disease I: The risk of gonorrhea transmission from infected women to men. Am J Epidemiol 1978; 108: 136–144.

    CAS  PubMed  Google Scholar 

  36. Weinstein MC, Graham JD, Siegel JE, Fineberg HV Cost-effectiveness analysis of AIDS prevention programs: Concepts, complications, and illustrations. In Turner CF, Miller HG, Moses LE, eds. AIDS: Sexual Behavior and Intravenous Drug Use. Washington DC National Academy Press; 1989.

    Google Scholar 

  37. Kaplan EH. Modeling HIV infectivity: Must sex acts be counted? J Acquired Immune Defic Syndr 1990; 3: 55–61.

    CAS  Google Scholar 

  38. Moses S, Plummer FA, Ngugi EN, Nagelkerke NJD, Anzala AO, Ndinya-Achola JO. Controlling HIV in Africa: Effectiveness and cost of an intervention in a high-frequency STD transmitter core group. AIDS 1991; 5: 407–411.

    Article  CAS  PubMed  Google Scholar 

  39. Anderson RM, May RM. Epidemiological parameters of HIV transmission. Nature 1988; 333: 514–519.

    Article  CAS  PubMed  Google Scholar 

  40. Holtgrave DR, Kelly JA. Preventing HIV/AIDS among high-risk urban women: The cost-effectiveness of a behavioral group intervention. Am J Public Health 1996; 86: 1442–1445.

    Article  CAS  PubMed  Google Scholar 

  41. Holtgrave DR, Kelly JA. The cost-effectiveness of an HIV/AIDS prevention intervention for gay men. AIDS and Behavior 1997; 1: 173–180.

    Article  Google Scholar 

  42. Pinkerton SD, Holtgrave DR, Valdiserri RO. Cost-effectiveness of HIV prevention skills training for men who have sex with men. AIDS 1997; 11: 347–357.

    Article  CAS  PubMed  Google Scholar 

  43. Holtgrave DR, Leviton LC, Wagstaff D, Pinkerton SD. The cumulative probability of HIV infection: A summary risk measure for HIV prevention intervention studies. AIDS and Behavior 1997; 1: 169–172.

    Article  Google Scholar 

  44. Pinkerton SD, Holtgrave DR, DiFranceisco WJ, Stevenson LY, Kelly JA. Cost-effectiveness of a community-level HIV risk reduction intervention. Am J Public Health, in press.

    Google Scholar 

  45. Pinkerton SD, Abramson PR. Not all behavior change is equivalent. Am J Public Health 1998; 88: 864.

    Google Scholar 

  46. Holtgrave DR, Quails NL. Threshold analysis and HIV prevention programs. Medical Decision Making 1995; 15: 311–317.

    Article  CAS  PubMed  Google Scholar 

  47. Brandeau ML, Owens DK, Sox CH, Wachter RM. Screening women of childbearing age for human immunodeficiency virus: A model-based policy analysis. Manage Sci 1993; 39: 72–92.

    Article  Google Scholar 

  48. Kaplan EH. Economic analysis of needle exchange. AIDS 1995; 9: 1113–1119.

    Article  CAS  PubMed  Google Scholar 

  49. Kaplan EH, Abramson PR. So what if the program ain’t perfect? A mathematical model of AIDS education. Evaluation Rev 1989; 13: 107–122.

    Article  Google Scholar 

  50. Downs AM, de Vincenzi I. Probability of heterosexual transmission of HIV: Relationship to the number of unprotected sexual contacts. J Acquired Immune Defic Syndr 1996; 11: 388–395.

    Article  CAS  Google Scholar 

  51. Wiley JA, Herschkorn SJ, Padian NS. Heterogeneity in the probability of HIV transmission per sexual contact: The case of male-to-female transmission in penile-vaginal intercourse. Stat Med 1989; 8: 93–102.

    Article  CAS  PubMed  Google Scholar 

  52. Jewell NP, Shiboski SC. Statistical analysis of HIV infectivity based on partner studies. Biometrics 1990; 46: 1133–1150.

    Article  CAS  PubMed  Google Scholar 

  53. Pinkerton SD, Holtgrave DR. Combination antiretroviral therapies for HIV: Some economic considerations. In Ostrow DG, Kalichman SC, eds. Psychosocial and Public Health Impacts of New HIV Therapies. New York: Plenum Press, 1998.

    Google Scholar 

  54. Pinkerton SD, Abramson PR. HIV vaccines: A magic bullet in the fight against AIDS? Evaluation Rev 1993; 17: 579–602.

    Article  Google Scholar 

  55. Pinkerton SD, Abramson PR. A magic bullet against AIDS? Science 1993; 262: 162–163.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, 53202, USA

    Steven D. Pinkerton

  2. Department of Psychology, University of California, Los Angeles, Los Angeles, California, 90024, USA

    Paul R. Abramson

Authors
  1. Steven D. Pinkerton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul R. Abramson
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, 53202, USA

    David R. Holtgrave Ph.D.

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer Science+Business Media New York

About this chapter

Cite this chapter

Pinkerton, S.D., Abramson, P.R. (1998). The Bernoulli-Process Model of HIV Transmission. In: Holtgrave, D.R. (eds) Handbook of Economic Evaluation of HIV Prevention Programs. AIDS Prevention and Mental Health. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1878-9_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4899-1878-9_2

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-1880-2

  • Online ISBN: 978-1-4899-1878-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation