1. You are in charge of HIV prevention in Sydney, Australia, which celebrates a 2-week long and Mardi Gras and is famous for the sexual liberties taken during that period. Which groups, from those listed below, do you target for interventions? Why? Assume that the probability of HIV transmission during an encounter is 0.03, and that condom use decreases this probability to 0.001. Show all calculations and state any assumptions made. In addition to any calculations, you should explain which group you decide to target and how (2 marks for discussion; approximately half a page).
a. Occasional sex workers with an average of 2 clients per day for 50 days per year. All use condoms when able, but the average rate of use is 5%. The HIV prevalence in this group is 15%. There are 1000 people in this group who live in Sydney year-round (1 mark for calculations).
b. HIV-positive vacationers who come to Sydney for Mardi Gras and who stay on average 2 weeks; they have on average 3 partners per day and engage in ‘risky behaviors’ that increase the HIV transmission probability to 0.06. You anticipate 5000 visitors with this profile (1 mark for calculations).
c. Professional sex workers with an average of 2 clients per day for 300 days per year. All use condoms when able and the average rate of use is 90%. The HIV prevalence in this group is 50%. There are 3000 people in this group, who live in Sydney year-round (1 mark for calculations).
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To determine which groups to target for HIV prevention interventions during the and Mardi Gras in Sydney, we need to consider the factors that contribute to the transmission of HIV in each group. We will calculate the number of potential transmissions in each group and compare them to decide which group requires more targeted interventions.
a. Occasional sex workers:
Number of people in the group = 1000
Average number of clients per day = 2
Number of days per year = 50
Condom use rate = 5%
HIV prevalence = 15%
Calculations:
Number of potential transmissions per year = Number of people × (Number of clients per day × Number of days per year) × (1 - Condom use rate) × HIV prevalence
= 1000 × (2 × 50) × (1 - 0.05) × 0.15
= 1000 × 100 × 0.95 × 0.15
= 1425
b. HIV-positive vacationers:
Number of people in the group = 5000
Average number of partners per day = 3
Probability of HIV transmission = 0.06 (due to risky behaviors)
Duration of stay during Mardi Gras = 2 weeks (14 days)
Calculations:
Number of potential transmissions during Mardi Gras = Number of people × (Average number of partners per day × Duration of stay) × Probability of HIV transmission
= 5000 × (3 × 14) × 0.06
= 5000 × 42 × 0.06
= 12600
c. Professional sex workers:
Number of people in the group = 3000
Average number of clients per day = 2
Number of days per year = 300
Condom use rate = 90%
HIV prevalence = 50%
Calculations:
Number of potential transmissions per year = Number of people × (Number of clients per day × Number of days per year) × (1 - Condom use rate) × HIV prevalence
= 3000 × (2 × 300) × (1 - 0.9) × 0.50
= 3000 × 600 × 0.1 × 0.50
= 9000
Discussion:
Comparing the potential transmissions in each group, we find that the highest number of potential transmissions occurs among the HIV-positive vacationers during Mardi Gras (12600). This group engages in risky behaviors that increase the probability of HIV transmission, making them a significant concern during the event. Therefore, targeting interventions towards this group would be crucial for HIV prevention efforts.
While both the occasional sex workers and professional sex workers have a considerable number of potential transmissions, it is important to note that their activities occur throughout the year and not just during Mardi Gras. Therefore, interventions targeting these groups should be implemented as part of regular HIV prevention efforts throughout the year in the city.
In summary, the group that requires the most targeted interventions during the and Mardi Gras in Sydney is the HIV-positive vacationers, due to their high potential for HIV transmission during the event. This would involve focusing on outreach programs, offering condom distribution, providing education on HIV prevention, and encouraging safer sexual practices among this group. Simultaneously, efforts should also continue throughout the year to address the needs of the occasional sex workers and professional sex workers in the community.