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Overview: the role of emergent properties of complex systems in the epidemiology and prevention of sexually transmitted infections including HIV infection
  1. Sevgi O Aral1,
  2. Jami S Leichliter1,
  3. James F Blanchard2
  1. 1Division of STD Prevention, The National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Sevgi O Aral, Division of STD Prevention, The National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-02, Atlanta, GA 30333, USA; saral{at}cdc.gov

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This supplement of Sexually Transmitted Infections highlights the role of emergent properties of complex systems in the epidemiology and prevention of sexually transmitted infections (STI) including HIV infection. All units of observation, measurement and intervention in STI epidemiology and prevention, including populations, behaviours, intervention packages and health systems through which interventions are delivered constitute complex systems with emergent properties. Emergent properties of complex systems thus play an important role in the extent and patterns of spread of infection; they also need to be considered in the development of prevention strategies including the choice of intervention packages; target populations and required coverage and duration of interventions. The following overview describes types of emergent properties of complex systems, many of which are reflected in the 15 articles compiled in the supplement, and summarises the main issues presented by the authors from theoretical, methodological, practical and policy perspectives.

Complex systems and emergent properties

The STI epidemiology and prevention literature has long reflected the recognition of multiple levels of causation of epidemiological patterns, prevention strategies and their impact.1 2 Discussions of individual and population-level approaches to epidemiology and prevention,1 and multilevel strategies for analysis of epidemiological data and planning and implementation of preventive interventions,2 have been around for over a decade and are well accepted. However, despite their inclusion in earlier publications, the constructs of complex systems marked by emergent properties inherent in the concepts of ‘population’ and ‘multilevel’, which have received increased attention in epidemiology in recent years, have not made their way into mainstream epidemiological and prevention thought in the STI/HIV field.

Simply stated, a complex system is made up of a large number of …

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