HIV Transmission Dynamics in Greater Mexico City are Shaped by Dense Spatial Mixing

Understanding HIV transmission in densely populated urban settings is essential to mitigate ongoing epidemic spread. We present a comprehensive analysis of recent HIV transmission dynamics in Greater Mexico City, one of the worlds largest metropolitan areas comprising Mexico City and neighbouring municipalities of the State of Mexico. Drawing from over 7,000 complete pol gene sequences representing around 50% of new cases reported between 2019 and 2022 within the study region, we reconstructed the transmission network based on pairwise genetic distance. We identified ten large transmission clusters exhibiting sustained growth up to the most recent sampling period. We further analysed paired genetic and high- resolution human mobility data using an integrated phylogeographic approach. We observed a heterogeneous pattern of viral spread across the region, supported by an extensive mixing at a wider geographic scale. Across Greater Mexico City, displaying a high population density, HIV transmission is minimally spatially constrained, a pattern likely fuelled by intense human mobility. Thus, population movement weakens isolation by distance in large urban areas even for a chronic infection that is sexually and vertically transmitted. We demonstrate the value of integrating large-scale genetic, epidemiological, and mobility data to resolve contemporary HIV transmission dynamics in densely populated urban settings