Lurie Mark N, Williams Brian G, Zuma Khangelani, Mkaya-Mwamburi David, Garnett Geoff P, Sweat Michael D, Gittelsohn Joel, Karim Salim S Abdool
South African Medical Research Council, HIV Prevention and Vaccine Research Unit, Durban, South Africa.
AIDS. 2003 Oct 17;17(15):2245-52. doi: 10.1097/00002030-200310170-00013.
To measure HIV-1 discordance among migrant and non-migrant men and their rural partners, and to estimate the relative risk of infection from inside versus outside primary relationships.
A cross-sectional behavioural and HIV-1 seroprevalence survey among 168 couples in which the male partner either a migrant, or not.
A detailed questionnaire was administered and blood was collected for laboratory analysis. A mathematical model was developed to estimate the relative risk of infection from inside versus from outside regular relationships.
A total of 70% (117 of 168) of couples were negatively concordant for HIV, 9% (16 of 168) were positively concordant and 21% (35 of 168) were discordant. Migrant couples were more likely than non-migrant couples to have one or both partners infected [35 versus 19%; P = 0.026; odds ratio (OR) = 2.28] and to be HIV-1 discordant (27 versus 15%; P = 0.066; OR = 2.06). In 71.4% of discordant couples, the male was the infected partner; this did not differ by migration status. In the mathematical model, migrant men were 26 times more likely to be infected from outside their regular relationships than from inside [relative risk (RR) = 26.3; P = 0.000]; non-migrant men were 10 times more likely to be infected from outside their regular relationships than inside (RR = 10.5; P = 0.00003).
Migration continues to play an important role in the spread of HIV-1 in South Africa. The direction of spread of the epidemic is not only from returning migrant men to their rural partners, but also from women to their migrant partners. Prevention efforts will need to target both migrant men and women who remain at home.
测定流动男性与非流动男性及其农村伴侣之间的HIV-1不一致情况，并估计主要关系内部与外部感染的相对风险。
对168对夫妻进行横断面行为和HIV-1血清流行率调查，其中男性伴侣为流动者或非流动者。
发放详细问卷并采集血液进行实验室分析。建立数学模型以估计常规关系内部与外部感染的相对风险。
共有70%（168对中的117对）夫妻HIV检测结果呈阴性一致，9%（168对中的16对）呈阳性一致，21%（168对中的35对）不一致。流动夫妻比非流动夫妻更有可能一方或双方感染[35%对19%；P = 0.026；优势比（OR）= 2.28]，且HIV-1检测结果更有可能不一致（27%对15%；P = 0.066；OR = 2.06）。在71.4%的不一致夫妻中，男性为感染方；这在流动状态方面没有差异。在数学模型中，流动男性从常规关系外部感染的可能性比从内部高26倍[相对风险（RR）= 26.3；P = 0.000]；非流动男性从常规关系外部感染的可能性比从内部高10倍（RR = 10.5；P = 0.00003）。
在南非，流动在HIV-1传播中继续发挥重要作用。疫情传播方向不仅是从返乡流动男性到其农村伴侣，也包括从女性到其流动伴侣。预防工作需要针对流动男性和留守在家的女性。
