Smith J, Nalagoda F, Wawer M J, Serwadda D, Sewankambo N, Konde-Lule J, Lutalo T, Li C, Gray R H
Department of Epidemiology, Johns Hopkins University, School of Hygiene and Public Health, Maryland, USA.
Int J STD AIDS. 1999 Jul;10(7):452-9. doi: 10.1258/0956462991914456.
We examined the association between education and prevalent HIV-1 infection in the Rakai district, rural Uganda based on a cross-sectional analysis of a population-based cohort. In 1990, 1397 men and 1705 women aged 13 years and older, were enrolled in 31 randomly selected communities. Strata were comprised of main road trading centres, secondary road trading villages and rural villages. Sociodemographic and behavioural data were obtained by interview and serum for HIV serostatus were obtained in the home. The analysis examines the association between sex-specific prevalent HIV infection and educational attainment, categorized as secondary, primary or none. The odds ratios (ORs) and 95% confidence intervals (95% CIs) of HIV infection were estimated, using no education as the referent group. Higher levels of education were associated with a higher HIV seroprevalence in bivariate analyses (OR 2.7 for primary and 4.1 for secondary education, relative to no education). The strength of the association was diminished but remained statistically significant after multivariate adjustment for sociodemographic and behavioural variables (adjusted OR of HIV infection 1.6 (95% CI: 1.2-2.1)) for primary education and 1.5 (95% CI: 1.0-2.2) for secondary education. Stratified multivariate analyses by place of residence indicated that the association between education and HIV prevalence was statistically significant in the rural villages, but not in the main road trading centres and intermediate trading villages. Educational attainment is a significant predictor of HIV risk in rural Uganda, in part because of risk behaviours and other characteristics among better educated individuals. Preventive interventions need to focus on better educated adults and on school-aged populations.
基于对一个以人群为基础的队列的横断面分析,我们研究了乌干达农村拉凯地区教育与HIV-1现患感染之间的关联。1990年,1397名年龄在13岁及以上的男性和1705名女性被纳入31个随机选择的社区。分层包括主要道路贸易中心、次要道路贸易村庄和农村村庄。通过访谈获取社会人口统计学和行为数据,并在家庭中采集血清检测HIV血清学状态。该分析考察了按性别划分的HIV现患感染与教育程度之间的关联,教育程度分为中学、小学或无教育。以未接受教育作为参照组,估计了HIV感染的优势比(OR)和95%置信区间(95%CI)。在双变量分析中,较高的教育水平与较高的HIV血清阳性率相关(相对于未接受教育,小学教育的OR为2.7,中学教育的OR为4.1)。在对社会人口统计学和行为变量进行多变量调整后,这种关联的强度有所减弱,但仍具有统计学意义(小学教育的HIV感染调整后OR为1.6(95%CI:1.2 - 2.1),中学教育的调整后OR为1.5(95%CI:1.0 - 2.2))。按居住地进行的分层多变量分析表明,教育与HIV流行率之间的关联在农村村庄具有统计学意义,但在主要道路贸易中心和中间贸易村庄则不然。在乌干达农村,教育程度是HIV风险的一个重要预测因素,部分原因是受教育程度较高的个体存在风险行为和其他特征。预防性干预措施需要关注受教育程度较高的成年人以及学龄人群。