Gregson Simon, Terceira Nicola, Mushati Phyllis, Nyamukapa Constance, Campbell Catherine
Wellcome Trust Centre for the Epidemiology of Infectious Disease, Oxford University, South Parks Road, Oxford OX1 3FY, UK.
Soc Sci Med. 2004 Jun;58(11):2119-32. doi: 10.1016/j.socscimed.2003.09.001.
The lifetime risk of acquiring HIV infection in many rural as well as urban areas of southern Africa is currently as high as two-in-three. For women, much of this risk still accrues rapidly at young ages despite high levels of knowledge about HIV/AIDS. Thus, programmes that are more participatory and address underlying structural and community-level factors appear to be essential. We use cross-sectional data from a large-scale, population-based survey in rural eastern Zimbabwe to describe the relationships between membership of different forms of community group and young women's chances of avoiding HIV. Our results show that participation in local community groups is often positively associated with successful avoidance of HIV, which, in turn, is positively associated with psychosocial determinants of safer behaviour. However, whether or not these relationships hold depends on a range of factors that include how well the group functions, the purpose of the group, and the education level of the individual participant. We identify factors that may influence the social capital value of community groups in relation to HIV prevention at the individual, group, and community levels. Young women with secondary education participate disproportionately in well-functioning community groups and are more likely to avoid HIV when they do participate. Longitudinal studies are needed: (i) to establish whether community group membership supports the development of safer lifestyles or merely has greater appeal to individuals already predisposed towards such lifestyles, and (ii) to pinpoint directions of causality between hypothesised mediating factors. In-depth research is needed on the specific qualities of community groups that enhance their contribution to HIV control. However, our findings suggest that promotion of and organisational development and training among community groups could well be an effective HIV control strategy.
在南部非洲的许多农村和城市地区，感染艾滋病毒的终生风险目前高达三分之二。对于女性而言，尽管她们对艾滋病毒/艾滋病有较高的认知水平，但其中很大一部分风险在年轻时仍会迅速增加。因此，更具参与性且能解决潜在结构和社区层面因素的项目似乎至关重要。我们利用来自津巴布韦东部农村地区一项大规模、基于人群的调查的横断面数据，来描述不同形式社区团体的成员身份与年轻女性避免感染艾滋病毒几率之间的关系。我们的结果表明，参与当地社区团体往往与成功避免感染艾滋病毒呈正相关，而这又与更安全行为的心理社会决定因素呈正相关。然而，这些关系是否成立取决于一系列因素，包括团体的运作情况、团体的目的以及个体参与者的教育水平。我们确定了在个体、团体和社区层面可能影响社区团体与艾滋病毒预防相关的社会资本价值的因素。受过中等教育的年轻女性不成比例地参与运作良好的社区团体，并且当她们参与时更有可能避免感染艾滋病毒。需要进行纵向研究：（i）以确定社区团体成员身份是支持更安全生活方式的发展，还是仅仅对已经倾向于这种生活方式的个体更具吸引力；（ii）以查明假设的中介因素之间的因果关系方向。需要对社区团体有助于艾滋病毒控制的具体特质进行深入研究。然而，我们的研究结果表明，促进社区团体的发展以及开展组织发展和培训很可能是一种有效的艾滋病毒控制策略。
