Bayesian projection of the acquired immune deficiency syndrome epidemic. Discussion

Short-term projections of the acquired immune deficiency syndrome (AIDS) epidemic in England and Wales have been regularly updated since the publication of the Cox report in 1988. The key approach for those updates has been the back-calculation method, which has been informally adapted to acknowledge various sources of uncertainty as well as to incorporate increasingly available information on the spread of the human immunodeficiency virus (HIV) in the population. We propose a Bayesian formulation of the back-calculation method which allows a formal treatment of uncertainty and the inclusion of extra information, within a single coherent composite model. Estimation of the variably dimensioned model is carried out by using reversible jump Markov chain Monte Carlo methods. Application of the model to data for homosexual and bisexual males in England and Wales is presented, and the role of the various sources of information and model assumptions is appraised. Our results show a massive peak in HIV infections around 1983 and suggest that the incidence of AIDS has now reached a plateau, although there is still substantial uncertainty about the future.