Objective: The aim of this study was to investigate introductions and spread of different HIV-1 subtypes in the Netherlands. Design: We identified distinct HIV-1 transmission chains in the... Show moreObjective: The aim of this study was to investigate introductions and spread of different HIV-1 subtypes in the Netherlands. Design: We identified distinct HIV-1 transmission chains in the Netherlands within the global epidemic context through viral phylogenetic analysis of partial HIV-1 polymerase sequences from individuals enrolled in the ATHENA national HIV cohort of all persons in care since 1996, and publicly available international background sequences. Methods: Viral lineages circulating in the Netherlands were identified through maximum parsimony phylogeographic analysis. The proportion of HIV-1 infections acquired in-country among heterosexuals and MSM was estimated from phylogenetically observed, national transmission chains using a branching process model that accounts for incomplete sampling. Results: As of 1 January 2019, 2589 (24%) of 10 971 (41%) HIV-1 sequenced individuals in ATHENA had non-B subtypes (A1, C, D, F, G) or circulating recombinant forms (CRF01AE, CRF02AG, CRF06-cpx). The 1588 heterosexuals were in 1224, and 536 MSM in 270 phylogenetically observed transmission chains. After adjustments for incomplete sampling, most heterosexual (75%) and MSM (76%) transmission chains were estimated to include only the individual introducing the virus (size = 1). Onward transmission occurred mostly in chains size 2-5 amongst heterosexuals (62%) and in chains size at least 10 amongst MSM (64%). Considering some chains originated in-country from other risk-groups, 40% (95% confidence interval: 36-44) of non-B-infected heterosexuals and 62% (95% confidence interval: 49-73) of MSM-acquired infection in-country. Conclusion: Although most HIV-1 non-B introductions showed no or very little onward transmission, a considerable proportion of non-B infections amongst both heterosexuals and MSM in the Netherlands have been acquired in-country. Show less
This introduction provides the context and theoretical background that informs the studies in this volume. It introduces the volume’s common theme: the question of how different actors give shape... Show moreThis introduction provides the context and theoretical background that informs the studies in this volume. It introduces the volume’s common theme: the question of how different actors give shape to BRI projects. It outlines how, rather than treating nation states as singular, monolithic actors, this volume teases apart the way different people and organizations insert themselves into BRI decision-making and implementation. The chapter discusses how we might conceptualize agency in such contexts, drawing together the volume’s findings to arrive at four conclusions: 1) that in understanding the BRI, geographical context matters; 2) that the BRI is a pluralist endeavour rather than a single, unified agenda; 3) that BRI efforts often extend rather than challenge existing politics; and 4) that outcomes depend on the activities of local actors. Show less
