Bibliographic record
Abstract
TO THE EDITOR—Wilson et al make an excellent point that we as a field are lacking direct estimates of the reduction in human immunodeficiency virus (HIV) transmission associated with anal intercourse among men who have sex with men (MSM) who are virologically suppressed [1]. The recent exciting finding of a 96% overall reduction in HIV transmission in discordant heterosexual couples randomized to early HIV treatment in HPTN 052 provides strong evidence for the dramatic effectiveness of antiretroviral therapy (ART) in reducing HIV infectiousness [2]. Similar evidence from a randomized study among HIV-discordant MSM couples, in whom HIV transmission dynamics are known to differ from those in heterosexuals, would be extremely valuable for both modeling epidemiologists and public health policymakers. Given the strength of the effect of ART on reducing HIV transmission, it is questionable whether a large-scale randomized trial in MSM would be acceptable for ethical reasons. While this is being debated, we can look to cities such as San Francisco, California, and Vancouver, British Columbia, where HIV incidence, ART coverage, and community viral load are closely monitored [3–5]. In our home city of San Francisco, we are seeing decreases in newly diagnosed and reported HIV infections that correlate well with the expansion of ART coverage and increases in the proportion of HIV-infected MSM who are virologically suppressed (a 39% increase between 2004 and 2008), all in the context of stable or increasing rates of HIV transmission risk behaviors and reported sexually transmitted infections among those uninfected with HIV. Of course, correlation is not causation, and the multiple factors that influence HIV transmission dynamics and could explain the modeled and observed differences between Sydney and San Francisco may not be fully appreciated in our studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.063 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.004 | 0.005 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.005 | 0.003 |
| Research integrity | 0.042 | 0.053 |
| Insufficient payload (model declined to judge) | 0.014 | 0.011 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".