Universidade Eduardo

Mondlane
HIV/AIDS Dynamics: Impact of
economic classes with transmission
from poor clinical settings
Sansao A. Pedro

, Jean M. Tchuenche

Mathematics and Computer Science Department, Eduardo Mondlane University, Box 257, Maputo,
Mozambique

Mathematics Department, University of Dar es Salaam, Box 35062, Dar es Salaam, Tanzania
sansaopedro@uem.mz/sansaopedro@gmail.com
1. Introduction
Understanding the relationship between social classes and the spread of HIV, including trans-
mission from clinical settings, may play a key role in addressing the HIV/AIDS epidemic in a
community. People with diferent social economic status should not be treated in the same
way. In many societies, economic status inuence peoples attitudes to sex, sexuality, risk
taking and delity. People living in rural areas and people with lower income are likely to
have lower comprehesive knowledge about AIDS. For these reasons, HIV/AIDS is inherently
a social economic based issue and needs to be seen in this light if it is to be addressed effec-
tively. Thus, it is along this background that this study was carried out to address HIV/AIDS
as an economic status-based issue in African heterosexual settings where many countries
are resource-poor nations.
2. The Model

u
p q u
r
(1-c)a ca

d
t p

t r

e
p

e
r

a p e r


o
r
k p k r
(1-a) p
p r
(1-e) r

d p d
r

P
r
A
p
A
r
S
p
S
r
P
H
A
H
I p
I r
P
p
Figure 2.1: Model ow diagram.
S

p
(t) = (1 ) Sp pSp + rSr Sp,
I

p
(t) = Sp pIp (1 a)pIp apIp + rIr Ip,
P

p
(t) = apIp + rPr pPp pPp Pp,
A

p
(t) = pPp + (1 a)pIp + rAr ( + dp)Ap,
S

r
(t) = Sr + pSp rSr Sr,
I

r
(t) = Sr + pIp rIr erIr (1 e)rIr Ir,
P

r
(t) = erIr rPr rPr rPr Pr,
A

r
(t) = rPr + (1 e)rIr rAr ( + dr)Ar,
P

H
(t) = pPp + rPr P
H
P
H
,
A

H
(t) = P
H
( + d)A
H
.
(1)
3. Reproduction number of the sexual and clinical transmission of HIV infection
sub-model
R
0
=

1
c(1 )
+
+
a
( + )( + )( + + )
= R
I
0
+ R
PH
0
. (2)
R
I
0
=
1c(1)
+
, is the reproduction number induced by transmission from infective individuals
I, while R
PH
0
=
a
(+)(+)(++)
is the reproduction number induced by transmission from
hospitalized individuals P
H
.
4. Impact of heterosexual and clinical transmissions
Now, differentiating R
0
partially with respect to
1
, and yields respectively
R
0

1
=
c(1 )
+
,
R
0

=
a
( + )( + )( + + )
, (3)
Based on the model parameters, the equations in (3) are always positive, implying that
an increase on the rates of heterosexual and clinical transmissions will always have
a detrimental population-level impact (increase disease burden) as this increases the
reproduction rate, thereby fueling the epidemic (increases the HIV prevalence).
(a) (b) (c)
0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 0.09 0.1
1.7935
1.794
1.7945
1.795
1.7955
1.796
1.7965
1.797
1.7975
contact rate
R
e
p
ro
d
u
c
tio
n
n
u
m
b
e
r
0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 0.09 0.1
0
0.5
1
1.5
2
2.5
3
3.5
contact rate
R
e
p
ro
d
u
c
tio
n
n
u
m
b
e
r
1 2 3 4 5 6 7 8 9 10
1.4
1.6
1.8
2
2.2
2.4
2.6
2.8
3
Number of partners
R
e
p
ro
d
u
c
tio
n
n
u
m
b
e
r
Figure 4.2: (a) Effects of clinical contact rate on R
0
, (b) Effects of heterosexual contact
rate
1
on R
0
, (c) Variation of basic reproductive number R
0
with number of partners c
5. Reproduction number of the general model
Rp
r
=
M + Q
2
+

(M Q)
2
+ 4PL
2
(4)
If the poor remain poor and rich remain rich (p = r = p = r = r = r = 0), then, Rpr
will be the sum of two reproduction numbers, namely: the poverty only reproduction number
(which occurs when p = r = p = r = r = r = = 0), and the rich only reproduction
number (which occurs when (p = r = p = r = r = r = 0), = 1), given respectively by
Rp =

1
p
cp(1 )( + )(p + p + ) + app
( + )(p + )(p + p + )
, Rr =

1
r
cr(1 )( + )(r + r + ) + arr
( + )(r + )(r + r + )
.
6. Numerical Simulations
Parameter Symbol Value Reference
Recruitment rates , p, r 475393 Estimate
Per-capita natural death rate 1/35yr
1
Estimate
Probabilities of transmission p, r, 0.04, 0.06, o.05 Estimate
Average numbers of sexual partners cp, cr, c 10 Estimate
Fraction of susceptibles having contact with hospitalized individuals 1.5% Estimate
Rates of movement of infectives to pre-AIDS class , p, r 0.2 [3]
Rates at which pre-AIDS individuals develop full blown AIDS , p, r 0.5 [3]
Fraction of infectives that progress normally to pre-AIDS stage a 0.3 [3]
Rates of susceptible individuals across different social status p, r 0.001, 0.01 [3]
Rates of infective individuals across different social status p, r 0.001, 0.01 [4]
Rates of Pr, Ar become poor r, r 0.01 [4]
Rates at which pre-AIDS individuals are hospitalized , r, p 0.4 Estimate
Rate at which hospitalized individuals progress to full blown AIDS 0.6 Estimate
AIDS induced death rates dp, dr, d 0.1916, 0.3831, 0.7562 Estimate
Table 1: Parameter values for the model
(a) (b) (c)
0 50 100 150 200 250 300 350 400 450 500
2
3
4
5
6
7
8
x 10
6
Time(years )
P
o
o
r a
n
d
ric
h
S
u
s
c
e
p
tib
le
s
poor
rich
0 50 100 150 200 250 300 350 400 450 500
0
2
4
6
8
10
12
14
x 10
5
Time(years )
P
o
o
r a
n
d
ric
h
In
fe
c
tiv
e
s
poor
rich
0 50 100 150 200 250 300 350 400 450 500
0
2
4
6
8
10
12
14
16
18
x 10
5
Time(years )
P
o
o
r a
n
d
ric
h
In
fe
c
tiv
e
s
poor
rich
(d) (f) (e)
0 50 100 150 200 250 300 350 400 450 500
0
2
4
6
8
10
12
14
x 10
4
Time(years )
P
o
o
r a
n
d
ric
h
p
re

A
ID
S
poor
rich
0 50 100 150 200 250 300 350 400 450 500
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
x 10
5
Time(years )
P
o
o
r a
n
d
ric
h
A
ID
S
poor
rich
0 50 100 150 200 250 300 350 400 450 500
0
2
4
6
8
10
12
14
x 10
4
Time(years )
p
re

A
ID
S
a
n
d
A
ID
S
H
o
s
p
ita
liz
e
d
preAIDS
AIDS
Figure 6.3: Time series evolution of poor and rich (a) Susceptibles, (b) Infectives, (c) pre-
AIDS, (d) AIDS, (e) pre-AIDS and AIDS hospitalized (A
H
), (f), using the following initial con-
ditions and parameter values Sp(0) = 15193568, Sp(r) = 3509714, Ip(0) = 621482, Ir(0) =
336036, p = p = 0.001, r = r = r = r = 0.01, r = 0.2, p = 0.3, p = r = 0.5, p =
r = 0.4, p = 0.04,
4
= 0.06 and a = e = 0.3.
7. Conclusion
The proposed model suggests a class differential as Men with better livelihood tend to have
more female sexual partners from the poor sugroup, and therefore, they have higher levels
of HIV infection than people with low income (poor residents) [5] (at least in Tanzania). Thus,
contrary to popular belief, this study shows that HIV seems to be most present in rich com-
munities, but develop faster in impoverished individuals, whence the high number of AIDS
cases and disease-induced death in resource-poor communities (nations).
References
[1] S.A. Pedro and J.M. Tchuenche (2010). HIV/AIDS Dynamics: Impact of economic classes
with transmission from poor clinical settings, J. Theor. Biol. 267 (2010) 471485.
[2] Z. Mukandavire, N. J. Malunguza, C. Chiyaka, G. Musuka, J.M. Tchuenche (2009)
HIV/AIDS model assessing the effects of gender-inequality affecting women in African
heterosexual settings, Int. J. Biomath., in press.
[3] R. Naresh et al (2006). Modelling the spread of AIDS epidemic with vertical transmission.
Applied Mathematics and Computation, 178, 262-272.
[4] Bhunu C.P. and Garira W. Assessing the effects of poverty in tuberculosis transmission
dynamics
[5] Tanzania HIV/AIDS and Malaria Indicator Survey 2007-08. National Bureau of Statistics
(NBS), Ofce of the Chief Government Statistician, The Tanzania Commission for AIDS
(TACAIDS) and the Zanzibar AIDS Commission (ZAC), November 2008.
NIAID/FLAD 2011 Conference on HIV/AIDS Research. A Collaborative Solution of Tropical Diseases: The Luso-American Response, September 7-9, 2011, Lisbon, Portugal.

Modelling Biomedical Systems Research Group